Ovarian torsion: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Abd DDX RLQ}} | |||
{{LLQ DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 10:05, 1 June 2015
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%)
Differential Diagnosis
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
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