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ovarian torsion: ct sensitivity

Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Radiopedia Case Ovarian Torsion https://radiopaedia.org/cases/ovarian-torsion-10?lang=us. The sensitivity of the individual signs ranged from 36.2% to 85.1%, … Evaluate the sensitivity and specificity of pelvic ultrasound (US) and abdominopelvic computed tomography (CT) for the identification of ovarian torsion in women presenting to the emergency department with acute lower abdominal or pelvic pain. Ovarian torsion should also be considered in infants and small children with feeding intolerance, abdominal distension, vomiting, irritability, and/or a palpable pelvic mass. The ovary must be untwisted as soon as possible to restore blood flow. Failure to establish the diagnosis in a timely fashion can result in irreversible ovarian ischemia with implications for future fertility. As with any emergency department patient, start with a primary assessment: airway, breathing, circulation. Eur J Radiol. Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9-100.0%) and 85.0% specific (95% CI, 64.0-94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9-97.2%) and 90.0% specific (95% CI, 69.9-97.2%) for reader 2. For US studies, the radiologists graded the adnexal Doppler waveforms as either normal or suspicious for torsion. Epub 2019 Oct 18. Ovarian torsion: a fifteen-year review. Imaging of common solid organ and bowel torsion in the emergency department. Images courtesy of Dr. Maulik S Patel. Conclusion:Identifying a twisted pedicle in a patient is therefore, suggestive of ovarian torsion. There is no absolute cutoff to ensure viability. [7] Treatment of adnexal torsion is surgical. Absence of Doppler flow has high specificity but low sensitivity. Presence of ovarian cysts was significantly associated with torsion. She has no past medical or surgical history (including no STD’s) and she has never been pregnant. The most common finding is an ovary > 4cm. While classically the pain is sudden in onset, this is not always the case. Predicting necrosis in adnexal torsion in women of reproductive age using magnetic resonance imaging. Among them, we found ovarian torsion in seven patients (53.8%) and an ovarian lesion without torsion in six (46.2%). COVID-19 is an emerging, rapidly evolving situation. Torsion does occur in infants, children, and postmenopausal women. Other symptoms may include nausea. Cureus. Any female patient who presents with abdominal pain should prompt consideration of torsion in ED providers. Sensitivity, specificity and interobserver variation were calculated for each imaging modality. It is important to remember that approximately 40% of patients will report gradual pain instead of the acute onset pain that is frequently associated with torsion and some patients may describe back or flank pain. Pregnancy also results in an increased risk of torsion due to an enlarged corpus luteum. US) that delays therapy is unlikely to improve preoperative diagnostic yield. In this study, we have adopted a case-based statistical analysis to identify important sonographic markers and further evaluated their contribution in identifying ovarian to… To investigate adnexal torsion, ultrasound is a good first‐line diagnostic test with a pooled sensitivity of 0.79 and specificity of 0.76. 2014; 83(4):733-8. Most surgeons will try to salvage any normal ovarian tissue in a premenopausal patient. The greatest risk factor for ovarian torsion is ovarian enlargement, typically caused by an ovarian cyst or mass. Pearls and pitfalls in diagnosis of ovarian torsion. 2019 Feb;59(2):126-132. doi: 10.1007/s00117-018-0475-4. The greatest percentage of cases occur in the reproductive years but torsion also occurs in children and post-menopausal females. 2014 Nov;203(5):W470-81. Early recognition and restoration of blood flow are important to avoid irreversible ovarian damage. A consultative transvaginal ultrasound was obtained which demonstrated a decreased Doppler flow to the right ovary. PURPOSE: Ovarian torsion (OT) is a true surgical emergency that requires prompt diagnosis and therapy. MRI findings are similar to those on CT, but  MRI is not commonly ordered from the ED. A markedly elevated serum white blood cell count may favor tubo-ovarian abscess over torsion. The remainder of findings on ultrasound and CT are nonspecific.  |  The cyst was decompressed and the pedicle of the right ovary was detorsed causing return of blood flow. Left maintains normal flow. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic evaluation. Establishing IV access and administering antiemetics and pain medication may aid in evaluation of the patient. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. 2020 Feb;30(2):1054-1061. doi: 10.1007/s00330-019-06434-y. While the overall incidence of ovarian torsion is low and there is almost no associated mortality, when missed, ovarian torsion can result in a significant degree of morbidity forRead More “Ovarian Torsion.” EmDOCs.net - Emergency Medicine Education, www.emdocs.net/. Lack of flow is a helpful sign, but remember that a significant number of patients with torsion confirmed on laparoscopy had an ultrasound that showed intact blood flow. Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9–100.0%) and 85.0% specific (95% CI, 64.0–94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9–97.2%) and 90.0% specific (95% CI, 69.9–97.2%) for reader 2. 2005; 17(3):231-7. The tube is dusky and engorged with engorgment of the ovary. Commonly an ovarian mass or cyst can be visualized and in, later stages, free pelvic fluid (indicating hemorrhage) can be seen. J Emerg Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. [7] The sensitivity and specificity of abnormal ovarian flow are 44% and 92%, respectively, with a positive and negative predictive value of 78% and 71%, respectively. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 What every radiologist should know about adnexal torsion. The respective sensitivity, specificity, and accuracy of a twisted pedicle for the diagnosis of ovarian torsion were 73%, 88%, and 78%, respectively for reader 1 and 73%, 100%, and 83%, respectively for reader 2. This leads to vascular congestion, which causes engorgement and edema. However, heightened awareness and suspicion of this condition are needed for timely intervention. Materials and methods This retrospective, single-institution case-control study included 43 women with adnexal torsion and 43 age- and ovarian mass-matched control women. Am J Surg. In my mind in a patient with undifferentiated abdominal pain and structurally normal ovaries I'm not sure that routinely adding an ultrasound would help us identify these extremely rare cases of torsion. The varied imaging features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. White M, Stella J. A CT in an adult female that shows normal sized and appearing ovaries likely excludes the diagnosis of torsion. The congestion progresses until arterial flow is compromised, leading to ischemia and infarction. Sensitivity and specificity were respectively 42.9% and 81.8% for B-Mode ultrasound and 100% and 81.8% for contrastenhanced ultrasonography. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Diagnostic testing is essential when evaluating a patient with suspected ovarian torsion.  |  Consult gynecology early if you have a high suspicion for torsion. Initial actions are similar to the evaluation of other patients in the ED. The bedside ultrasound was inconclusive. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. 2014 Apr;21(2):179-87. doi: 10.1007/s10140-013-1163-3. BACKGROUND: The diagnosis of ovarian torsion … Positive Doppler flow to the ovary does not rule out torsion. Emergency GYN consult is required in all suspected ovarian torsion cases. CT in ovarian torsion is nonspecific, with the most common finding being an enlarged ovary or ovarian mass. 2019. Interobserver agreement was excellent (Kappa=0.85). A bedside transabdominal ultrasound was obtained to evaluate for possible free abdominal/pelvic fluid. Keywords: Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. COPYRIGHT © 2021 SAEM, ALL RIGHTS RESERVED. Both CT and US seem like reasonable tests to identify the presence of underlying ovarian pathology. Untreated ovarian torsion can result in complete loss of the ovary, as well as ovarian necrosis and infection. Pena JE, Ufberg D, Cooney N, et al. In this study, we performed a meta-analysis of all the published studies on B-mode ultrasound (US, morphological criteria), Doppler US (DUS, flow criteria), and computed tomography (CT) for the diagnosis of OT. HHS She is slightly obese but is otherwise well-appearing. Bridwell, Rachel. Women with pathologically low flow are more likely to have torsion. Emerg Med Australas. This site needs JavaScript to work properly. A complete blood count, basic metabolic panel, and urinalysis can provide additional information pointing you toward an alternative diagnosis. Diagnosing ovarian torsion in the emergency department remains a challenge. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. The objective of this thesis is to determine the trends in usage of CT scanning and its sensitivity during the workup of pelvic pain and suspected torsion. CT images were evaluated independently by two readers for the … The initial twisting causes obstruction of venous return. [Acute Pelvic pain in women-gynecological causes]. Rapid urine or serum pregnancy testing should be obtained. CT has high sensitivity in the diagnosis of cystic teratomas [3]. Amidst an increasingly busy winter flu season, you encounter a 25 year old female with acute onset abdominal pain. Ovarian torsion represents a true gynecological emergency and requires rapid evaluation and management in order to salvage the ovary. The most common ultrasound finding in torsion is enlargement or edema of the ovary. NLM Abdominopelvic CT for ovarian torsion was 100.0% sensitive (95% CI, 83.9-100.0%) and 85.0% specific (95% CI, 64.0-94.5%) for reader 1, while 90.0% sensitive (95% CI, 69.9-97.2%) and 90.0% specific (95% CI, 69.9-97.2%) for reader 2. Ovarian torsion can occur in all ages.  |  [Sudden chest pain and lower abdominal pain : The usual suspects]. “Ovarian Torsion.” UpToDate, 10 Apr. Objective The purpose of our study was to assess computed tomographic (CT) findings of adnexal torsion through a matched case-control analysis. [13] For Tubo-Ovarian Abscess (TOA): doi: 10.7759/cureus.12192. Even if a dusky, edematous ovary is discovered in the OR, there is often functional recovery if the tissue is not necrotic. Reader 1 had no CT false negatives. She denies fever, vaginal bleeding, discharge, dysuria or change in bowel habits. Look for corroborating evidence on pelvic exam: adnexal tenderness on the same side as the pain and, less commonly, an adnexal mass. Duan N, Rao M, Chen X, Yin Y, Wang Z, Chen R. Eur Radiol. Torsion is more common in an ovary that is greater than 5.0 cm in diameter (86 to 95% per multiple case studies.) Keep the patient NPO in preparation for the OR. Conclusion: We compared the CT and MR imaging findings in adnexal torsion in patients with versus those without hemorrhagic infarction in terms of the presence of tube thickening, size of the twisted ovarian mass, wall thickness of the twisted ovarian mass, and presence of ascites and uterine deviation using the Student t test and the Fisher exact two-tailed test. Ovarian/adnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. There is a significant diagnostic delay at 101.8 hours (median). It is more commonly seen in the right ovary due to an increased length of the utero-ovarian ligament on the right and the presence of the sigmoid colon on the left. For ovarian torsion: A retrospective study of 834 patients showed the NPV of a contrast enhanced CT of the pelvis for ovarian torsion is 100%. If all your tests are negative, but you still suspect it, call your gynecologist to discuss taking the patient to the OR for laparoscopy. Would you like email updates of new search results? She complains of persistent nausea and multiple episodes of vomiting. Des Plaines, IL 60018 AJR Am J Roentgenol. The Clerkship Directors in Emergency Medicine (CDEM) is an Academy of SAEM. Image 1. The risk goes down when the size of the ovary becomes more massive (> 20.0 cm) due to decreased motility. The bottom line – there is no single finding that can definitively “rule in” or “rule out” ovarian torsion. The diagnosis of ovarian torsion is made definitively in the operating room. A pelvic exam demonstrates right adnexal fullness and significant pain on exam without bleeding or discharge. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy should increase your suspicion for torsion. As they predispose to ovarian torsion [2], they may present with acute pelvic pain. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Rush Medical College, Originally Written By: Lynne Yancey University of Colorado School of Medicine. PMID: 15953224 Ultrasound is the diagnostic modality of choice for detecting torsion. 1111 East Touhy Ave, Suite 540 Houry DL, Abbott JT. Appendicitis or kidney stone as an alternate diagnosis ovarian pathology 2001 ; 38 ( 2 ) 156-159. 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