title: Torsion of normal adnexa in postmenarcheal women: can ultrasound indicate an ischemic process?
abstract: OBJECTIVE
  Torsion of normal adnexa is a rare event involving steadily increasing congestion and ischemia of the ovary. We investigated whether this process can be characterized by sonographic features.
  
  
  METHODS
  Twelve menstrually cycling women with 14 separate episodes of laparoscopic-proven torsion of normal adnexa were identified retrospectively, and the results of their preoperative gray-scale ultrasound examinations and Doppler flow evaluations were analyzed. The cases were classified into 'short-term' (< 24 h; range, 3-24 h) and 'prolonged' (> 24 h; range, 1-10 days) duration of torsion according to the reported period of abdominal pain before admission. Absence of any additional adnexal pathology was confirmed by both intraoperative inspection and postoperative follow-up ultrasound examinations.
  
  
  RESULTS
  The median age of the cohort was 24.0 (interquartile range (IQR), 20.5-28.7) years, and parity ranged from 0 to 3. All affected ovaries were significantly enlarged compared with non-affected ones (median cross-sectional area, 18.1 (IQR, 12.4-26.4) cm(2) vs. 4.3 (IQR, 2.9-6.2) cm(2), P < 0.01). We could distinguish two distinct sonographic patterns of torted ovaries: there were numerous small peripheral follicles in the ovarian parenchyma in nine cases, and there was a solid-appearing mass with hypo- and hyperechogenic foci in five cases. Comparison of the ultrasound images of patients with short-term vs. long-term abdominal pain revealed that the solid-appearing ovary was more common in the latter group (0/6 vs. 5/8, P = 0.03), while there was no significant difference between groups in the presence of free pelvic fluid or median ovarian cross-sectional area. Intraovarian blood flow was diminished or absent in five of the eight patients in whom color Doppler imaging was performed.
  
  
  CONCLUSIONS
  Ultrasound images of twisted normal adnexa may vary according to the duration of the condition, reflecting the pathological series of events of increased ovarian congestion and necrosis. Recognition of the different sonographic features of twisted normal adnexa may assist in the correct diagnosis of these patients.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Smorgick
authors.forename: R
authors.initials: R
authors.lastname: Maymon
authors.forename: S
authors.initials: S
authors.lastname: Mendelovic
authors.forename: A
authors.initials: A
authors.lastname: Herman
authors.forename: M
authors.initials: M
authors.lastname: Pansky
mesh_terms: D000290:Adnexa Uteri / Q000000981:diagnostic imaging*; D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000328:Adult; D005184:Fallopian Tube Diseases / Q000000981:diagnostic imaging; D005187:Fallopian Tubes / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging*; D007813:Laparotomy; D010049:Ovarian Diseases / Q000000981:diagnostic imaging; D010053:Ovary / Q000098:blood supply / Q000000981:diagnostic imaging; D012039:Regional Blood Flow; D014102:Torsion Abnormality / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*