OC12.03: Ultrasonographic signs for diagnosing adnexal torsion

Adnexal torsion is more frequently diagnosed in women of reproductive age. The early identification of ultrasound signs of adnexal torsion in women with acute or subacute pelvic pain is crucial in order to apply the correct treatment, avoiding unnecessary oophorectomy. To evaluate the ultrasound characteristics of adnexal torsion, according the ultrasonographic signs described in a recent meta-analysis. This was a retrospective study of 89 patients with surgically confirmed diagnosis of adnexal torsion, defined as surgical view of ovarian pedicle, paraovarian cyst and/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between January 2010 and March 2024. We evaluate the presence of five ultrasound features reported to be characteristic of adnexal torsion: (1) adnexal mass, (2) ovarian stromal edema, (3) the whirlpool sign, (4) Doppler colour (absent vs present), (5) the follicular ring sign, (6) intrafollicular fluid-debris level and (7) free fluid in the pouch of Douglas. A total of 89 cases of adnexal torsion were identified, 73 of them with a previous ultrasonographic scan. The median age of the patients was 35 (range, 10-72) years. Adnexal mass vas detected in 61 (83.6%). Ovarian stromal edema was reported in 56 (76.7%) patients, the whirlpool sign in 25 (34.2%) patients, absent colour Doppler signals in the twisted organ in 39 (53.4%) patients, follicular ring sign in 23 (31.5%) patients and intrafollicular fluid-debris level in 30 (41.1%). Free fluid in the pouch of Douglas was detected in 36 (49.3%) patients. The most common ultrasound signs in the evaluation of adnexal torsion are the presence of adnexal mass and ovarian stromal edema and the less common the follicular ring sign. The knowledge of these features conducts to the diagnosis of ovarian torsion, allowing the correct treatment.