DIAGNOSING OVARIAN TORSION WITH COMPUTED-TOMOGRAPHY - A CASE-REPORT

BACKGROUND: The diagnosis of adnexal torsion is difficult to make on t he basis of symptoms, physical findings or radiologic techniques. Unfo rtunately, delayed intervention can lead to irreversible damage and lo ss of the adnexa. This report describes a finding seen on computed tom ography (CT) that may increase suspicion of the diagnosis of ovarian t orsion. CASE: A 21-year-old woman was admitted with constant abdominal pain and a tender retrouterine mass. Ultrasound failed to provide a d efinitive diagnosis. CT showed a central, hypodense area consistent wi th fat and surrounded by a shell of intermediate density. At laparotom y the patient was found to have a necrotic left adnexa due to torsion. Bisection of the adnexal mass confirmed a dermoid cyst with overlying edematous ovarian cortex. CONCLUSION: The observation of a round, hyp odense central lesion (dermoid cyst) surrounded by thickened, edematou s ovarian cortex on CT is a finding that may aid in the diagnosis of a dnexal torsion. The finding is a thickened shell of ovarian cortex sur rounding a central mass that has caused the torsion; in this case it w as a dermoid.