Ovarial Torsion in Young Children. Ultrasound Diagnostic

Background. Early adnexal torsion (AT) is extremely rare. It usually involves a torsion of the ovary together with the tube, which cannot be differentiated by transabdominal ultrasound, so the terms "adnexal torsion" and "ovarian torsion" for children are echographically identical. Objective. To study the features of echographic representation of ovarian torsion in infant girls. Materials and Methods . During 2015–2024, adnexal torsion was echographically diagnosed in 6 girls of the first year of life. All patients underwent transabdominal ultrasound in B-mode and color Doppler scanning. All children were operated, and the diagnosis was verified. Results. The frequency of adnexal torsion in children under 1 year of age was 13.3% of all patients (45) with this pathology. The complaints and clinical picture were nonspecific. In all cases, suspicion of adnexal torsion was expressed only when ultrasound was performed. There was an increase in the volume of the affected ovary by 6.91 ± 0.68 times compared to the contralateral ovary and increased echogenicity of the ovarian parenchyma, against which numerous anechogenic follicles were traced. Vascular pattern in the parenchyma of the affected ovary was detected in 2/6 cases (33.33%), uterine appendages were irreversibly changed. Hyperstimulated ovaries were observed in 4 out of 6 cases. The distribution of follicles in the affected ovary was chaotic, there was no "necklace symptom", there was no marked rounding of the ovarian shape, and the amount of stromal component in the tilted ovary was relatively small. In 5/6 (83.3%) girls, no pelvic cavity effusion was noted. Conclusion There are no specific anamnestic and clinical data suggestive of adnexal torsion in infants, which determines the importance of ultrasound as virtually the only method of emergency diagnosis of this pathology. The peculiarity of ultrasound in the infant should be the maximum expansion of the area of examination with attempts to visualize the pelvic organs regardless of the degree of bladder filling. The basis of echographic diagnosis of adnexal torsion in infants are structural changes of the appendage in B-mode: increase in linear size of 1.5–2 times, volume of 4–10 times and increased echogenicity of the stroma. Rounding of the shape of the affected ovary is insignificant. A feature of twisted appendage in infants is a large number of follicles in the affected ovary (2/3 of observations). The "necklace" symptom is atypical. The presence of abdominal effusion in adnexal torsion in infants is not characteristic. Preservation of the vascular pattern in the ovary does not exclude adnexal torsion, is infrequent (in 1/3 of cases) and does not guarantee preservation of ovarian viability.