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Ovarian Torsion MR

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This is an MRI of a patient who presented with

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exquisite right lower quadrant pelvic pain.

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Now, this patient is not pregnant, but the

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features of this case are so classic that

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I feel it's important to show it to you.

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This patient had a pelvic ultrasound,

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which demonstrated an enlarged right ovary.

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However, when they did that exam, they felt

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they were able to see flow to the right ovary.

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In light of the patient's

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persistent pain, an MRI was ordered.

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This is a T2 fat-saturated image of the pelvis.

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As we scroll down, we can nicely see

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the distinct layers of the uterus,

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the uterine serosa, myometrium,

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junctional zone, and endometrium.

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We can very clearly identify the

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left ovary, which has multiple T2

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hyperintense follicles within it.

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As we scroll inferiorly into the pelvis,

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we see a large, relatively T2 hyperintense

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mass, with multiple peripherally located

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well-circumscribed T2 hyperintensities.

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There's a small amount of surrounding

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free fluid, and also surrounding what are

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follicles in this enlarged right ovary,

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we can see a rim of T2 hypointensity.

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This is perifollicular hemorrhage

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in this patient with peripheral

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displacement of the ovarian follicles.

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As we scroll superiorly back toward the

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uterus, we can see a classic whirlpool

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sign where the vascular pedicle extending

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from the right lateral aspect of the uterus

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toward the right ovary is swirling on

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itself in this patient with ovarian torsion.

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Because this patient is not pregnant, we

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were also able to administer intravenous

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gadolinium-based contrast for this MRI.

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And in this post-contrast image of the

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pelvis, we can see that there's relative

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global hypoenhancement of the right ovary,

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which was infarcted at the time of surgery.

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So this is a case of ovarian torsion with

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unfortunately ovarian infarction on MRI.

Report

Faculty

Erin Gomez, MD

Assistant Professor of Radiology

Johns Hopkins Hospital

Tags

Women's Health

Vascular

Ovaries

Neoplastic

MRI

Gynecologic (Gyn)

Gynecologic (GYN)

Genitourinary (GU)

Body

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