title: Multimodality imaging findings of massive ovarian edema in children.
abstract: BACKGROUND
  Massive ovarian edema is a rare benign condition that predominantly affects childbearing women as well as preadolescent girls. It is thought to result from intermittent or partial torsion of the ovary compromising the venous and lymphatic drainage but with preserved arterial supply. The clinical features of massive ovarian edema are nonspecific and can simulate tumors, leading to unnecessary oophorectomy.
  
  
  OBJECTIVE
  To demonstrate imaging features that should alert radiologists to consider the diagnosis of massive ovarian edema preoperatively so that fertility-sparing surgery may be considered.
  
  
  METHODS
  We identified five girls diagnosed with massive ovarian edema at pathology. Presenting symptoms, sidedness, imaging appearance, preoperative diagnosis, and operative and histopathological findings were reviewed.
  
  
  RESULTS
  Age range was 9.6-14.3 years (mean age: 12.5 years). Common imaging findings included ovarian enlargement with edema of the stroma, peripherally placed follicles, isointense signal on T1-W MRI and markedly hyperintense signal on T2-W MRI, preservation of color Doppler flow by US, and CT Hounsfield units below 40. The uterus was deviated to the affected side in all patients. Two of the five patients had small to moderate amounts of free pelvic fluid. Mean ovarian volume on imaging was 560 mL (range: 108-1,361 mL).
  
  
  CONCLUSIONS
  While the clinical presentation of massive ovarian edema is nonspecific, an enlarged ovary with stromal edema, peripherally placed follicles and preservation of blood flow may be suggestive and wedge biopsy should be considered intraoperatively to avoid unnecessary removal of the ovary.
authors.affiliation: Department of Radiology, Neuroradiology Division, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA.
authors.forename: Hisham
authors.initials: H
authors.lastname: Dahmoush
authors.affiliation: Department of Radiology, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104-4399, USA.
authors.forename: Sudha A
authors.initials: SA
authors.lastname: Anupindi
authors.affiliation: Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Pawel
authors.affiliation: Department of Radiology, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104-4399, USA. chauvinn@email.chop.edu.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Chauvin
mesh_terms: D000293:Adolescent; D002648:Child; D003287:Contrast Media; D004487:Edema / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods*; D010049:Ovarian Diseases / Q000000981:diagnostic imaging*; D010053:Ovary; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Children; Computed tomography; Edema; Magnetic resonance imaging; Massive ovarian edema; Ovary; Tumor; Ultrasound