Ovarian torsion: Difference between revisions
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* cysts greater than 4cm more likely to torse | * cysts greater than 4cm more likely to torse | ||
*dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis | *dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis | ||
**sonographer should document dual arterial and venous waveforms | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 16:27, 24 October 2013
Background
- Occurs in females of all ages (most common in reproductive age women)
- Ovarian cysts (usually > 5 mm) and neoplasms account for 94% of cases in adults
- Account for only 50% in children (much more likely to torse normal ovaries)
Pathophysiology
- cysts greater than 4cm more likely to torse
- dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis
- sonographer should document dual arterial and venous waveforms
Clinical Features
- Nausea/vomiting ~ 70%
- Sudden and sharp pain in the lower abdomen ~ 59%
- can be intermittent
- Fever ~ <2%
DDx
- Ectopic Pregnancy
- Ruptured or hemorrhagic cyst
- Appendicitis
- PID
- Fibroid (degenerating)
- Endometriosis
- In Vitro fertilization
- Spontaneous AB
Diagnosis
- Ultrasound (sensitivty 46-70%)
- Diminished or absent blood flow in the ovarian vessels
- Ovarian mass
- Gold standard: direct visualization!
Treatment
- Emergent OB/GYN consult in ED
Source
- UpToDate
- Tintinalli