Ovarian torsion
Revision as of 09:36, 1 June 2015 by Rossdonaldson1 (talk | contribs)
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
- 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