0:01

This is an ultrasound of the pelvis in a

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patient presenting with exquisite, relatively

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acute onset right lower quadrant pain.

0:10

Again, this patient is not pregnant, but it's

0:12

an important illustration of the diagnosis.

0:15

We see transabdominal images of the

0:17

pelvis at the level of the uterus, and the

0:20

sonographer is measuring the bladder here.

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In addition to uterine measurements,

0:25

which are shown on these images, we also begin to

0:28

see a mass that is adjacent to the uterus in

0:31

the pelvis, which is relatively hypoechoic.

0:36

This is a color Doppler image of the

0:39

periuterine mass, which shows that

0:41

it has almost no internal blood flow.

0:45

The sonographer has labeled this mass

0:47

adjacent to the uterus as the right ovary.

0:50

Again, we can see that the ovary is enlarged.

0:53

It's heterogeneously hypoechoic.

0:56

And when we put color Doppler over the right

0:59

ovary, there is minimal internal blood flow.

1:02

The ovary is measuring 5.5 by 3.9 by

1:04

24 00:01:05,760 --> 00:01:05,949

1:05

7.1 centimeters, which is significantly enlarged.

1:09

In general, the ovaries should be almond-shaped

1:12

and should measure 2 by 3 by 4 centimeters.

1:16

I'd like to point out on these spectral Doppler

1:18

images that the sonographer has demonstrated

1:23

a vascular waveform within the ovary.

1:27

And we can see that there is sort of a mixed

1:30

arterial and venous waveform present here.

1:33

This can be a pitfall in the ultrasound

1:35

diagnosis of ovarian torsion if the

1:37

sonographer samples a vessel that is

1:40

in the periphery of the ovary rather

1:42

than the centrally avascular portion.

1:46

And so despite this ovary being torsed

1:49

and infarcted, a vessel in the periphery

1:51

of the ovary was sampled, leading to

1:54

the false impression that there was

1:56

maintained blood flow to the ovary.

1:59

The left ovary is clearly identified in the

2:01

left adnexa and is normal in size measuring 3.9 by 2.2

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46 00:02:05,740 --> 00:02:06,579

2:06

by 1.9 centimeters.

2:08

These are transvaginal images of the pelvis

2:11

where we can see higher resolution and greater

2:13

detailed images of the enlarged right ovary.

2:17

Again, we can see that it is

2:18

heterogeneously hypoechoic.

2:21

There is peripheral displacement of the ovarian

2:23

follicles and relatively patchy echogenicity and

2:27

hypoechogenicity within the ovarian parenchyma.

2:31

This is a color doppler image of

2:33

the enlarged right ovary, again

2:34

showing minimal internal blood flow.

2:37

It's also important to note that during the

2:39

endovaginal examination, the patient was

2:41

exquisitely tender to transducer palpation.

2:45

Again, spectral Doppler shows a vessel in the

2:47

periphery of the ovary that was sampled, which

2:50

did have a positive arterial waveform present.

2:53

However, this is again a pitfall in

2:55

the diagnosis of ovarian torsion.

2:57

If a vessel that is too peripheral is

2:59

sampled, you can have the false impression

3:01

that there is still blood flow to the ovary.

3:05

And we also see a moderate amount

3:08

of free fluid in the pelvis.

3:10

So this is a case of a misdiagnosis

3:13

of ovarian torsion on ultrasound.