See to Believe: The Clinical Gaps in the Utility of Ultrasound Imaging in Screening for Ovarian Torsion

Ovarian torsion is a gynecologic emergency requiring prompt diagnosis and intervention to prevent ischemic damage and loss of ovarian function. However, its diagnosis remains challenging due to nonspecific symptoms and limitations in imaging modalities. This case report presents two patients with suspected ovarian torsion based on ultrasound findings, both of whom were ultimately found to have alternative diagnoses. One patient underwent surgery, revealing an ovarian endometrioma rather than torsion, while the other was spared unnecessary surgery after MRI findings clarified the diagnosis. These cases underscore the limitations of ultrasound with Doppler as a standalone diagnostic tool and highlight the need for a multimodal imaging approach, incorporating CT or MRI in equivocal cases. A more nuanced analysis is warranted, one that takes into consideration different subpopulations of women by age range and menopausal status to refine clinical management, and also looks at certain diagnostic and imaging features that present within these specific patient groups that can aid in confirming torsion and expediting care. By integrating additional imaging techniques and leveraging emerging diagnostic tools, clinicians can improve accuracy, reduce morbidity, and ensure that surgical intervention is increasingly reserved for true cases of ovarian torsion.