Diagnostic Ultrasound - Abdomen and Pelvis

Adnexal/Ovarian Torsion
(Left) Longitudinal
endovaginal ultrasound shows
a 11 cm unilocular adnexal
cyst with scattered internal
echoes. A torsed ovary from a
mature cystic teratoma was
found at surgery. Most cases
of adult torsion have an
underlying mass, which acts as
a lead point. (Right)
Transverse endovaginal
ultrasound shows an enlarged
heterogenous ovary in a
patient with adnexal torsion.
Doppler ultrasound shows
preserved arterial flow. It is
important to remember that
normal Doppler waveforms
may be present in torsion.
Diagnoses: Female Pelvis
(Left) Axial NECT obtained in a
woman with acute pelvic pain
initially thought to be a renal
stone shows an oval 6 cm right
adnexal hyperdense mass ſt a
surrounded by small volume of
free fluid. (Right) Subsequent
endovaginal ultrasound in the
same woman shows an
enlarged ovary ſt with
heterogenous stroma,
peripheral follicles, and no
color Doppler flow, which is
consistent with adnexal
torsion.
(Left) Longitudinal
endovaginal ultrasound in a
32-year-old woman with acute
severe pain shows a large,
thick-walled large cyst ſt in
the cul-de-sac surrounded by a
dilated fallopian tube seen in
cross section . (Right)
Transverse endovaginal US of
the left adnexa in the same
woman shows the large cyst
with a thick wall ſt along the
broad ligament, separate from
a normal left ovary .
Fallopian tube torsion was
suspected preoperatively and
confirmed at surgery.
Fallopian tube torsion is rare,
but can occur in isolation.
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