Interactive Transcript
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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.
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Again, this patient is not pregnant, but it's
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an important illustration of the diagnosis.
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We see transabdominal images of the
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pelvis at the level of the uterus, and the
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sonographer is measuring the bladder here.
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In addition to uterine measurements,
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which are shown on these images, we also begin to
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see a mass that is adjacent to the uterus in
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the pelvis, which is relatively hypoechoic.
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This is a color Doppler image of the
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periuterine mass, which shows that
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it has almost no internal blood flow.
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The sonographer has labeled this mass
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adjacent to the uterus as the right ovary.
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Again, we can see that the ovary is enlarged.
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It's heterogeneously hypoechoic.
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And when we put color Doppler over the right
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ovary, there is minimal internal blood flow.
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The ovary is measuring 5.5 by 3.9 by
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24 00:01:05,760 --> 00:01:05,949
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7.1 centimeters, which is significantly enlarged.
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In general, the ovaries should be almond-shaped
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and should measure 2 by 3 by 4 centimeters.
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I'd like to point out on these spectral Doppler
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images that the sonographer has demonstrated
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a vascular waveform within the ovary.
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And we can see that there is sort of a mixed
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arterial and venous waveform present here.
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This can be a pitfall in the ultrasound
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diagnosis of ovarian torsion if the
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sonographer samples a vessel that is
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in the periphery of the ovary rather
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than the centrally avascular portion.
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And so despite this ovary being torsed
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and infarcted, a vessel in the periphery
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of the ovary was sampled, leading to
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the false impression that there was
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maintained blood flow to the ovary.
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The left ovary is clearly identified in the
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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
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by 1.9 centimeters.
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These are transvaginal images of the pelvis
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where we can see higher resolution and greater
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detailed images of the enlarged right ovary.
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Again, we can see that it is
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heterogeneously hypoechoic.
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There is peripheral displacement of the ovarian
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follicles and relatively patchy echogenicity and
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hypoechogenicity within the ovarian parenchyma.
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This is a color doppler image of
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the enlarged right ovary, again
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showing minimal internal blood flow.
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It's also important to note that during the
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endovaginal examination, the patient was
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exquisitely tender to transducer palpation.
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Again, spectral Doppler shows a vessel in the
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periphery of the ovary that was sampled, which
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did have a positive arterial waveform present.
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However, this is again a pitfall in
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the diagnosis of ovarian torsion.
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If a vessel that is too peripheral is
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sampled, you can have the false impression
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that there is still blood flow to the ovary.
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And we also see a moderate amount
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of free fluid in the pelvis.
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So this is a case of a misdiagnosis
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of ovarian torsion on ultrasound.
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