Ovarian and adnexal torsion - Spectrum of sonographic findings with pathologic correlation

Objective. To determine the spectrum of sonographic findings on gray scale and color Doppler sonography in a series of pathologically proven cases of ovarian and adnexal torsion. Methods. The study population included 15 pati ents with surgical confirmation of ovarian or adnexal torsion, or both, who underwent sonographic examination before surgery. All sonograms were revie wed retrospectively. Results Gray scale abnormalities included the followin g: complex masses in 11 (73%) of 15 patients, cystic masses in 3 (20%), and a solid mass in 1 (7%). Cul-de-sac fluid was present in 13 (87%) of 15 pat ients. Adnexal neoplasms were present in 4 (27%) of 15 (1 granulosa cell tu m-or and 3 dermoid cysts) on pathologic examination. Doppler findings were abnormal in 14 (93%) of 15 patients and normal in 1 (7%), Abnormal Doppler findings included no arterial and no venous flow in 6 (40%) of 15, decreas ed venous flow with no arterial flow in 5 (33%), decreased venous flow and decreased arterial flow in 2 (13%), and decreased arterial flow with no ven ous flow in 1 (7%). Small amounts of cul-de-sac fluid were present in 13 (8 7%) of 15 patients. Conclusions. The diagnosis of ovarian and adnexal torsi on remains challenging. It cannot be based solely on the absence or presenc e of flow on color Doppler sonography, because the presence of arterial or venous flow does not exclude the diagnosis of adnexal torsion. Comparison w ith the morphologic appearance and flow patterns of the contralateral ovary will aid in diagnosis.