0:01

Okay, another non-neoplastic mass that we

0:04

can think about, and I say mass because it's

0:06

something that's enlarged and occupying space,

0:09

but not really a lesion, is ovarian torsion.

0:12

And it can also present as a pseudomass,

0:15

and this is definitely a diagnosis that

0:16

we don't want to miss, but obviously

0:18

this is not something that's growing

0:20

because of cell proliferation, but

0:22

rather because of an obstruction to flow.

0:25

So ovarian torsion can present, and

0:28

usually presents, with an enlarged ovary.

0:30

The follicles tend to be displaced

0:33

peripherally because of edema

0:34

within the central ovarian stroma.

0:37

And because the ovary becomes enlarged,

0:40

it tends to cause the uterus to

0:42

displace towards the twisted side.

0:45

And then we often have blood vessel

0:47

engorgement on the twisted side.

0:48

And on MRI, we may see quite

0:50

significant ovarian edema, which is

0:53

high signal on T2-weighted images.

0:56

Sometimes you can see hemorrhagic infarction,

0:58

which is low signal on T2-weighted images, and

1:00

that tends to happen in a delayed presentation.

1:03

So quite often, and almost uniformly, these

1:07

patients will get an ultrasound prior to an

1:09

MRI, because this happens on an emergent basis.

1:12

So here we've got a very enlarged

1:14

looking ovary, and then we've got a quite

1:17

significant central ovarian stroma with

1:20

peripherally displaced follicles, which

1:22

is pretty typical for a torsion pattern.

1:25

And we've got done a Doppler study

1:28

here, which shows some arterial flow.

1:31

It's kind of a low-resistance

1:32

waveform, which is good.

1:33

But when we look at the venous flow,

1:36

we're seeing signal on both sides of

1:38

the baseline, which suggests that there

1:40

is noise rather than true venous flow.

1:43

And this was a case of a partial

1:45

intermittent ovarian torsion.

1:47

On CT we have a companion case here, which

1:51

was a case of torsion from a preexisting mass.

1:54

So we've got this very large inflamed

1:57

looking structure containing fluid and a

1:59

fluid level in the right hemipelvis.

2:02

It's causing displacement of the uterus,

2:04

which looks really, really thickened

2:07

and abnormal, and there's a lot of

2:08

inflammation in the adjacent fat.

2:11

And this was a hard call to make just based

2:13

on these three images, but it turned out this

2:16

patient had torsion and necrosis of the ovary.

2:19

And this was due to a preexisting mass.

2:21

So the reason I mentioned this now is because

2:24

we're learning about ovarian mass as we

2:26

have to be aware that any patient with an

2:28

ovarian mass is at risk of ovarian torsion.