WOMEN’S IMAGING 609 Adnexal Torsion: Review of Radio- logic Appearances Adnexal torsion is the twisting of the ovary, and often of the fal- lopian tube, on its ligamental supports, resulting in vascular com- promise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condi- tion predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corrobora- tive US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clini- cally suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating de- finitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across differ- ent modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflam- matory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent condi- tions to consider in the differential diagnosis are a ruptured hemor- rhagic ovarian cyst, massive ovarian edema, ovarian hyperstimula- tion, and a degenerating leiomyoma. Online supplemental material is available for this article. © RSNA, 2021 • radiographics.rsna.org M.Taufiq Dawood, BSc, MBBS, MRCP, FRCR Mitesh Naik, BSc, MBBS, MRCP, FRCR Nishat Bharwani, BSc, MBBS, MRCP, FRCR Siham A. Sudderuddin, BSc, MBBS, MRCP, FRCR Andrea G. Rockall, MBBS, MRCP, FRCR Victoria R. Stewart, BMedSci, BMBS, MRCP, FRCR RadioGraphics 2021; 41:609–624 https://doi.org/10.1148/rg.2021200118 Content Codes: From the Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.). Presented as an educa- tion exhibit at the 2019 RSNA Annual Meeting. Received May 11, 2020; revision requested June 25 and received September 9; accepted Septem- ber 21. For this journal-based SA-CME activity, the author A.G.R. has provided disclosures (see end of article); all other authors, the editor, and the reviewers have disclosed no relevant relation- ships. Address correspondence to M.T.D. (e- mail: [email protected]). © RSNA, 2021 After completing this journal-based SA-CME activity, participants will be able to: Summarize the typical clinical manifes- tation of adnexal torsion. List the imaging features of adnexal torsion seen at US, CT, and MRI. Discuss important differential diag- noses based on imaging appearances to avoid potential misinterpretations. See rsna.org/learning-center-rg. SA-CME LEARNING OBJECTIVES Introduction Torsion is defined as the twisting of an organ or part of an organ along its own axis (1). Torsion of the adnexa is a gynecologic emer- gency that affects approximately 2%–3% of females who present with acute pelvic pain (2–4). Both the ovary and the fallopian tube typically are involved; hence, the preferred term adnexal torsion rather than ovarian torsion (5). However, these terms are generally used interchangeably in clinical practice. The ovary and fallopian tube twist on their vascular and ligamental supports, causing interrupted perfusion that is initially due to venous and lymphatic conges- tion and subsequently caused by compromise to arterial flow. Less commonly, torsion of the fallopian tube in isolation or torsion of extraovarian (paratubal or paraovarian) cysts also can occur. Despite being relatively uncommon, adnexal torsion is an important cause of morbidity, and its nonspecific manifestations can prove to be a diagnostic challenge. To avoid ovarian infarction and the possibility of associated subfertility, early detection is critical. This copy is for personal use only. To order printed copies, contact [email protected]
Adnexal Torsion: Review of Radiologic Appearances
Jun 18, 2023
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