Uterine adnexal torsion: sonographic findings.

TLDR

Acute torsion of the uterine adnexal structures is a recognized surgical emergency, yet preoperative diagnosis based on imaging is rarely achieved. The study aimed to describe 16 cases in which sonographic findings suggested adnexal torsion preoperatively and to emphasize that recognizing this entity in the appropriate clinical context can improve salvage rates. The authors reviewed 16 cases, using sonography to identify torsion preoperatively and confirming the diagnosis at surgery. All 16 patients exhibited a pelvic or pelvoabdominal mass on sonography, most of which were cystic adnexal masses with variable internal septae, and symptom severity did not correlate with sonographic features.

Abstract

Acute torsion of the uterine adnexal structures (ovary and fallopian tube) is a recognized surgical emergency, but rarely has the diagnosis been made preoperatively on the basis of imaging studies. This report describes 16 cases in which the diagnosis was suggested preoperatively on the basis of sonography and subsequently confirmed at surgery. In all of the patients studied, a pelvic or pelvoabdominal mass was present on sonography. These masses had a sonographic texture ranging from cystic to solid, depending on the presence and extent of internal hemorrhage and/or stromal edema. In the majority of patients (13 of 16), adnexal torsion was associated with a preexisting cystic adnexal mass. Eight of these had thin internal septae. The severity of symptoms was variable and did not correlate directly with the sonographic features of the pelvic mass. Consideration of this entity in the proper clinical setting and with the typical sonographic findings will facilitate prospective recognition of adnexal torsion, thereby improving the chances for salvage of the involved adnexal structures.