Purpose or Case Report: Purpose
Ovarian torsion is rare in neonates and infants. Clinical diagnosis is challenging in the setting of lack of specific symptoms and the limitations in assessing pain in infants. Torsed ovaries in this patient population are also a diagnostic dilemma on imaging. In this study we reviewed the spectrum of imaging findings with pathologic correlation in a large series of patients.
Methods & Materials:
This was an IRB-approved HIPAA compliant retrospective study. All cases of ovarian torsion at a large standalone children's hospital were identified by queries of a radiology database and a hospital wide ICD code database. Out of a total number of 103 cases of ovarian torsion found between 2005 and 2014, imaging and clinic-pathologic data of 15 patients under one year of age diagnosed with ovarian torsion were reviewed. The age range was 0-10 months, with 14 out of the 15 patients being aged 0-4 months at the time of diagnosis.
Results: Four patients had an abdominal mass detected by prenatal ultrasound. Ten patients underwent exploratory laparotomy, while 4 were followed up to resolution with serial ultrasounds for complex cystic lesions presumed to represent torsed in-utero ovaries between 6 and 22 months after initial exam. One patient is still undergoing serial ultrasounds.
Ultrasound findings included large cysts with layering echogenic debris and no adjacent ovarian tissue in 10 patients, one hemorrhagic cyst with lace-like reticular echoes, 2 solid avascular masses and 2 small simple ovarian cysts surrounded by ovarian tissue. The large cysts with echogenic debris were found to represent largely necrotic and fibrotic tissue with foci of hemorrhage, granulation changes and dystrophic calcifications at pathology, with no viable ovarian tissue, consistent with remote torsion. Two of these lesions were mobile in the abdomen, consistent with autoamputation. The solid lesions corresponded to necrotic tissue and old blood with extensive calcification, also consistent with remote torsion. The 2 patients with small cysts had pathologic features of acute ovarian torsion.
Conclusions: We present a spectrum of imaging findings in neonatal and infantile ovarian torsion. Increased awareness can help in diagnosing and differentiating from other benign and malignant abdominal masses encountered in this patient population. In our series of patients, large cysts with layering echogenic debris represented the most common imaging finding, however solid lesions may also be encountered.