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Sonographic findings of ovarian torsion in children

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Abstract

Background

The clinical diagnosis of ovarian torsion is challenging and findings on pelvic sonography can be pivotal in making the correct diagnosis.

Objective

To determine the sonographic characteristics in children of surgically and pathologically proven ovarian torsion.

Material and methods

We performed a retrospective review of the sonograms and medical records of 41 patients with surgically and pathologically proven ovarian torsion at a pediatric hospital between 1994 and 2005. All sonograms were reviewed retrospectively by two pediatric radiologists with attention to the size, echotexture, location, presence of peripheral round cysts, and evidence of flow on Doppler sonography within the torsed ovary. The amount of free pelvic fluid was also recorded.

Results

The most common sonographic finding of ovarian torsion was an enlarged ovary/adnexal mass. All torsed adnexa were larger than the normal contralateral ovary, with the median volume 12 times that of the normal contralateral side. The majority (61%, n = 25) of the torsions occurred on the right. Color flow, either venous or arterial, was present in 62% (n = 21/34) of the torsed ovaries for which flow on Doppler sonography was documented. In 63% of the torsed ovaries (n = 26), the torsed adnexa appeared heterogeneous. Ovarian or para-ovarian pathology that may have acted as a potential lead point was present in 55% (n = 24) of torsed ovaries. The volume ratio of the torsed to normal ovary can predict the presence of an ovarian mass within the torsed ovary. In 70% of torsed ovaries with a volume ratio greater than 20, an ovarian mass was present, and in approximately 90% of those with a volume ratio less than 20, an internal mass was absent.

Conclusion

An enlarged heterogeneous appearing ovary is the most common finding in ovarian torsion. The presence or absence of flow by Doppler sonography is not helpful in the diagnosis. The volume ratio of the torsed to the normal ovary can predict the presence of an internal mass within the torsed adnexa.

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Acknowledgement

We are grateful for the work of Rhonda Johnson and Juliet Palinkas. We also thank Dr. Robert Lebowitz for his suggestions and insightful comments.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital Boston, Boston, MA, USA

    Sabah Servaes, David Zurakowski & Jeanne S. Chow

  2. Department of Orthopedic Surgery, Children’s Hospital Boston, Boston, MA, USA

    David Zurakowski

  3. Department of Surgery, Division of Gynecology, Children’s Hospital Boston, Boston, MA, USA

    Marc R. Laufer

  4. Department of Surgery, Children’s Hospital Boston, Boston, MA, USA

    Neil Feins

  5. Department of Radiology, Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Sabah Servaes

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  1. Sabah Servaes
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  2. David Zurakowski
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  3. Marc R. Laufer
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  4. Neil Feins
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  5. Jeanne S. Chow
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Correspondence to Sabah Servaes.

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Servaes, S., Zurakowski, D., Laufer, M.R. et al. Sonographic findings of ovarian torsion in children. Pediatr Radiol 37, 446–451 (2007). https://doi.org/10.1007/s00247-007-0429-x

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  • DOI: https://doi.org/10.1007/s00247-007-0429-x

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