Interactive Transcript
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Okay, another non-neoplastic mass that we
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can think about, and I say mass because it's
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something that's enlarged and occupying space,
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but not really a lesion, is ovarian torsion.
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And it can also present as a pseudomass,
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and this is definitely a diagnosis that
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we don't want to miss, but obviously
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this is not something that's growing
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because of cell proliferation, but
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rather because of an obstruction to flow.
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So ovarian torsion can present, and
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usually presents, with an enlarged ovary.
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The follicles tend to be displaced
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peripherally because of edema
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within the central ovarian stroma.
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And because the ovary becomes enlarged,
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it tends to cause the uterus to
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displace towards the twisted side.
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And then we often have blood vessel
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engorgement on the twisted side.
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And on MRI, we may see quite
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significant ovarian edema, which is
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high signal on T2-weighted images.
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Sometimes you can see hemorrhagic infarction,
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which is low signal on T2-weighted images, and
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that tends to happen in a delayed presentation.
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So quite often, and almost uniformly, these
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patients will get an ultrasound prior to an
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MRI, because this happens on an emergent basis.
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So here we've got a very enlarged
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looking ovary, and then we've got a quite
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significant central ovarian stroma with
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peripherally displaced follicles, which
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is pretty typical for a torsion pattern.
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And we've got done a Doppler study
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here, which shows some arterial flow.
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It's kind of a low-resistance
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waveform, which is good.
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But when we look at the venous flow,
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we're seeing signal on both sides of
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the baseline, which suggests that there
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is noise rather than true venous flow.
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And this was a case of a partial
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intermittent ovarian torsion.
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On CT we have a companion case here, which
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was a case of torsion from a preexisting mass.
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So we've got this very large inflamed
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looking structure containing fluid and a
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fluid level in the right hemipelvis.
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It's causing displacement of the uterus,
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which looks really, really thickened
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and abnormal, and there's a lot of
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inflammation in the adjacent fat.
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And this was a hard call to make just based
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on these three images, but it turned out this
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patient had torsion and necrosis of the ovary.
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And this was due to a preexisting mass.
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So the reason I mentioned this now is because
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we're learning about ovarian mass as we
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have to be aware that any patient with an
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ovarian mass is at risk of ovarian torsion.
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