Purpose or Case Report: Ovarian torsion in pediatrics is challenging to diagnose, both clinically and radiologically. Ultrasound is most commonly used to evaluate for this process, though there are no sonographic findings that are pathognomonic. One sonographic finding that has been infrequently reported in the literature is medialization of the ovary (defined as the ovary at or crossing the midline of the uterus), as the adnexal structures are drawn inwards by the twisted broad ligament. Knowledge of this finding in addition to the other more classic findings of torsion can be an important clue to the diagnosis. This study evaluates the presence of ovarian medialization in a large number of cases of known torsion.
Methods & Materials: All cases of ovarian torsion at a large standalone children's hospital were identified retrospectively by queries of a radiology database and a hospital wide ICD code database after IRB approval. 103 cases were included between 2005 and 2014. Imaging for each case was reviewed and presence or absence of medialization was recorded. Other imaging features were also evaluated, including ovary size and size ratio (compared to the contralateral side), Doppler vascular flow, follicular pattern, associated mass, and free fluid. Percentage of positive findings for each was calculated. Comparison to values in the literature were performed.
Results: Ovarian medialization was present in 60/103 patients. No contralateral (non-torsed) ovaries were found to be medialized. Other findings associated with torsion show similar frequency compared to that in the literature.
Conclusions: Ovarian medialization occurs in the majority of cases of torsion, though is not sensitive enough to exclude torsion as a solitary finding. Increased awareness of medialization, used in conjunction with other more well known findings along with the clinical scenario will aid in efficiently diagnosing torsion.