EP23.18: Unusual and previously undescribed signs of adnexal torsion: “figure‐eight”, “the mass with the tail”, “fimbriae resembling papillations”

The accurate preoperative ultrasound (US) diagnosis of adnexal torsion (AT) is challenging, characterised by low sensitivity and high specificity. A retrospective, single-centre study, encompassing surgical treatments performed on 416 patients with AT during the period of 8 year. Preoperative US images were available for retrospective analysis in 80 of those cases. Among them, classical US signs of AT previously described by various authors (such as the whirlpool sign, follicular ring, peripheral follicle pattern, stromal edema) were observed in 55/80 cases. We identified US signs not previously described, including “figure-eight with a waist”, “the mass with the tail”, and “fimbriae resembling papillations”. These signs were detected in 18/80 patients within the studied cohort. SUS and endoscopic images are presented. The sensitivity of classical US signs in diagnosing AT was found to be 64.7%, with a specificity of 97.5%. The US sign “figure-eight with a waist” is present in cases of the mesentero-axial type of adnexal or tubal torsion when the mass and the surgical pedicle form two parts, the general contour of which resembles figure “8”. In the studied cohort, this sign was noted in 10/80 cases. The sign “the mass with the tail” (presented in 8/80 patients) arises from direct visualization of the adnexal lesion and a small lateral adjacent area – the torniquet of its surgical pedicle. In 2/80 patients with hydrosalpinx torsion, “fimbriae resembling papillations” were observed. This occurred because the image of the fimbrial segment of the twisted tube overlaid onto the image of the hydrosalpinx, while the vascularity of the fimbrial segment was retained, mimicking the US appearance of papillations with an impression about high risk of malignancy. Even though the described new patterns are rarely observed in AT, these signs can optimise the diagnosis and slightly increase the sensitivity of preoperative US, especially when combined with other symptoms.