The Sonographic Diagnosis of Ovarian Torsion: Pearls and Pitfalls

Adnexal torsion is the fifth most common gynecologic emergency, but the diagnosis remains a clinical and imaging enigma. Although the most consistent presenting symptom is abdominal and pelvic pain, the diagnosis of torsion is complicated by its vague clinical presentation. The use of pelvic sonography has enhanced our ability to accurately evaluate patients at risk for ovarian torsion. The sonographic appearance of an enlarged ovary or ovarian complex without accompanying arterial or venous Doppler signal is usually diagnostic. Then again, the grayscale appearance in postpubertal patients is nonspecific, and the presence of Doppler signal cannot eliminate the diagnosis. This article endeavors to provide the reader with an approach to this often difficult diagnosis.