Pediatric Ovarian Torsion

  • Etiology: twisting of ovary causing decreased arterial flow (but ovary has dual blood supply from ovarian + uterine arteries)
  • US: enlarged ovary with multiple peripheral cysts, can see arterial flow to torsed ovary in ovarian torsion
  • Clinical: large ovarian cysts / tumors are predisposing factor for torsion

Radiology Cases of Ovarian Torsion

MRI of ovarian torsion
T1 coronal (left) and T1 sagittal (right) and T2 axial (below) MRI images show a heterogeneous intraperitoneal mass that appears to have hemorrhagic and calcified components. In the operating room this mass was found to be torsed.
US and CT of ovarian dysgerminoma with torsion
Transverse and sagittal US of the pelvis (above) shows an echogenic and inhomgenous solid mass superior to the bladder. Neither ovary could be visualized. Axial CT with contrast of the abdomen shows a solid non-enhancing midline mass.

Surgery Cases of Ovarian Torsion

Surgery image of ovarian torsion
Surgical image (above) shows the right ovary to be enlarged and purple in color (upper right of image), while the normal left ovary is small in size and white (middle of the image). Surgical image (below) further shows the enlarged right ovary twisted 360 degrees upon its pedicle.
Surgical image of ovarian torsion
Surgical image shows a large circular and soft mass that was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum and which was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.
Surgical image of ovarian dysgerminoma causing ovarian torsion
Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.

Gross Pathology of Ovarian Torsion

Gross pathology image of in-utero ovarian torsion
Gross pathological image (above) shows the mass to be circular and cystic. Upon sectioning, the thin-walled cyst was filled with hemorrhagic, fibrinous material (below). Solid areas were not present.
Gross pathology image of in-utero ovarian torsion
Gross pathological image shows the mass to be circular and cystic (above). Upon sectioning, the thin-walled cyst was filled with hemorrhagic and fibrinous material (below).