title: Imaging Findings of Fetal-Neonatal Ovarian Cysts Complicated With Ovarian Torsion and Autoamputation.
abstract: OBJECTIVE
  Large nonresolving neonatal ovarian cysts may be a risk factor for complications such as torsion, mass effect, rupture, intracystic hemorrhage, and autoamputation. Torsed cysts and autoamputated cysts can cause a diagnostic dilemma. The objective of our study was to correlate the imaging findings of intrauterine ovarian torsion and autoamputated ovaries with their pathologic findings.
  
  
  METHODS
  We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation notes, and pathologic reports of 15 patients with ovarian torsion. All patients had complex cysts noted on postnatal sonographic examination. A complex heterogeneous ovarian cyst was defined by the presence of a fluid-debris level indicating hemorrhage within the cyst, a retracting clot, septations with or without internal echoes, calcification, and a solid component.
  
  
  RESULTS
  On ultrasound examination, four cysts had solid components, and 11 were heterogeneous and had a fluid-debris level. Calcifications were seen in two patients. The mean patient age at the time of surgery was 3.9 months. Exploratory laparotomy was performed on all patients. Torsed ovaries were identified in five patients. Ten patients had ovaries that were floating free in the peritoneal cavity at the time of surgery. Histopathologic evaluation revealed that 11 of the cysts consisted of extensive hemorrhagic, necrotic autolytic tissue with dystrophic calcification. None of the cysts contained any ovarian tissue.
  
  
  CONCLUSIONS
  A complex heterogeneous ovarian cyst with a fluid-debris level indicating hemorrhage is a significant sonographic hallmark for the diagnosis of ovarian torsion. A calcified abdominal mass, with or without wandering, can be an autoamputated ovary.
authors.affiliation: 1 Department of Radiology, Hacettepe University Medical School 06100 Ankara, Turkey.
authors.forename: H Nursun
authors.initials: HN
authors.lastname: Ozcan
authors.affiliation: 1 Department of Radiology, Hacettepe University Medical School 06100 Ankara, Turkey.
authors.forename: Serife
authors.initials: S
authors.lastname: Balci
authors.affiliation: 2 Department of Pediatric Surgery, Hacettepe University Medical School, Ankara, Turkey.
authors.forename: Saniye
authors.initials: S
authors.lastname: Ekinci
authors.affiliation: 1 Department of Radiology, Hacettepe University Medical School 06100 Ankara, Turkey.
authors.forename: Altan
authors.initials: A
authors.lastname: Gunes
authors.affiliation: 1 Department of Radiology, Hacettepe University Medical School 06100 Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Oguz
authors.affiliation: 2 Department of Pediatric Surgery, Hacettepe University Medical School, Ankara, Turkey.
authors.forename: Arbay Ozden
authors.initials: AO
authors.lastname: Ciftci
authors.affiliation: 1 Department of Radiology, Hacettepe University Medical School 06100 Ankara, Turkey.
authors.forename: Mithat
authors.initials: M
authors.lastname: Haliloglu
mesh_terms: D000671:Amputation, Surgical; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010048:Ovarian Cysts / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014102:Torsion Abnormality / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016216:Ultrasonography, Prenatal
keywords: intrauterine ovarian torsion; ultrasonography