Subtorsion of the ovary: sonographic features and clinical management.
OBJECTIVE
To define the sonographic imaging criteria of ovarian subtorsion.


METHODS
Fourteen women 16 to 35 years of age with suspected unilateral twisted ovaries were sonographically evaluated in a tertiary care center before laparoscopy. Transvaginal sonography was performed to determine the longest ovarian dimension, diameter of the periovarian vessels, and degree of intraovarian blood flow and to evaluate ovarian morphology. Laparoscopy was performed to verify the sonographic findings and to perform detorsion.


RESULTS
All ovaries with subtorsion were of normal size, although still significantly longer than the contralateral, normal ovaries (47.5 and 29.6 mm, respectively; P = .001). The mean diameter of the periovarian vessels was significantly greater for the ovaries with subtorsion than the normal ovaries (29.9 and 19.2 mm, respectively; P= .0001). At laparoscopy, the ovary was twisted less than 180 degrees in 9 patients and 180 degrees to 360 degrees in 5. The degree of twisting correlated significantly with the size of the ovary (P = .016) and diameter of the periovarian vessels (P = .046). The 3-month sonographic follow-up after detorsion revealed bilateral normal ovarian dimensions with proper follicular growth.


CONCLUSIONS
Congestion of the periovarian vessels with normal ovarian morphology and persistent blood flow on sonography, combined with the presence of appropriate clinical signs, may be indicative of ovarian subtorsion.
Shalev
J
J
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel.
Mashiach
R
R
Bar-Hava
I
I
Girtler
O
O
Bar
J
J
Dicker
D
D
Meizner
I
I
D000328:Adult; D001783:Blood Flow Velocity; D003560:Cysts / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D010053:Ovary / Q000033:anatomy & histology / Q000098:blood supply*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000601:surgery; D018608:Ultrasonography, Doppler