Purpose or Case Report: Massive ovarian edema (MOE) is a rare benign condition that affects childbearing women including girls. MOE is thought to result from intermittent or partial torsion of the ovary compromising the venous and lymphatic drainage but with preserved arterial supply. The clinical features of MOE are nonspecific and can simulate tumors, frequently resulting in oopherectomy. Fertility-sparing surgery may be undertaken if the diagnosis is considered prospectively and intraoperatively with a wedge biopsy, avoiding unnecessary resection of the affected ovary. We present clinical presentations and imaging features that should alert pediatric radiologists to the diagnosis of MOE.
Methods & Materials: The Institutional Review Board approved the research protocol. A list of radiology and pathology reports performed from January 2005 to November 2014 containing the words “Massive Ovarian Edema” in patients 18 years or younger were populated using a search engine (Softek Illuminate^®). Two radiologists retrospectively reviewed the clinical presentation, imaging findings, and operative reports of patients who had confirmed massive ovarian edema on histopathology.
Results: We identified five subjects, mean age 12.5 years (range 9.6–14.3 years) with the diagnosis of massive ovarian edema at pathology. Presenting symptom, side, imaging appearance, preoperative diagnosis and intraoperative findings are detailed in Table 1. Common imaging findings included: ovarian enlargement with edema of the stroma, peripheral placed follicles with preservation of blood flow, MR: isointense signal on T1WI and markedly hyperintense signal on T2WI (Figure 1), preservation of color Doppler flow by ultrasound (Figure 2) and CT Hounsfield units below 40. The uterus was deviated to the affected side in all cases. 2/5 cases had small to moderate amount of free pelvic fluid. At pathology, the mean ovarian volume was 560 mL (range 108-1361).
Conclusions: While the clinical presentation of MOE is non-specific, an enlarged ovary with stromal edema, peripherally placed follicles and preservation of blood flow could suggest MOE and wedge biopsy should be considered intraoperatively to avoid unnecessary removal of the ovary in girls.