Subtorsion of the ovary - Sonographic features and clinical management

Objective. To define the sonographic imaging criteria of ovarian subtorsion . Methods. Fourteen women 16 to 35 years of age with suspected unilateral t wisted ovaries were sonographically evaluated in a tertiary care center bef ore laparoscopy. Transvaginal sonography was performed to determine the lon gest ovarian dimension, diameter of the periovarian vessels, and degree of intraovarian blood flow and to evaluate ovarian morphology. Laparoscopy was performed to verify the sonographic findings and to perform detorsion. Res ults. All ovaries with subtorsion were of normal size, although still signi ficantly longer than the contralateral, normal ovaries (47.5 and 29.6 mm, r espectively; P=.001). The mean diameter of the periovarian vessels was sign ificantly greater for the ovaries with subtorsion than the normal ovaries ( 29.9 and 19.2 mm, respectively; P =.0001). At laparoscopy, the ovary was tw isted less than 180 in 9 patients and 180 to 360 degrees in 5. The degree o f twisting correlated significantly with the size of the ovary (P=.016) and diameter of the periovarian vessels (P=.046). The 3-month sonographic foll ow-up after detorsion revealed bilateral normal ovarian dimensions with pro per follicular growth. Conclusions. Congestion of the periovarian vessels w ith normal ovarian morphology and persistent blood flow on sonography combi ned with the presence of appropriate clinical signs, may be indicative of o varian subtorsion.