Purpose or Case Report: Adnexal torsion is the most common gynecological emergency in children and adolescents. Early diagnosis is crucial. The diagnosis of torsion requires a summation analysis of clinical, laboratory, and imaging findings. Adnexal torsion may mimic abnormalities of the gynecological (such as ectopic pregnancy and pelvic inflammatory diseases ), genito-urinary (such as renal or ureteric stones), and gastrointestinal tract abnormalities (mostly, appendicitis and inflammatory bowel disease like Crohn's). Gastrointestinal causes mimicking torsion may also include less likely abnormalities of the upper GI tract, including liver, gall bladder, pancreatic, and ulcer disease. Additionally, rare tumor masses may be a direct cause of ovarian or para-ovarian torsion or may simulate the pain.

We present a spectrum of imaging cases showing simulators of ovarian torsion as well as a spectrum of actual gynecological system torsions, including those of the ovaries and para-ovarian structures in the pediatric population. We review the fundamental potential diagnostic pitfalls that may falsely suggest an adnexal torsion as well as imaging features to help evaluate adnexal and para-adnexal torsion.

Imaging plays a critical role in the diagnosis of adnexal torsion and its simulators. We demonstrate imaging findings of those simulators as well as in adnexal torsion. Our study emphasizes primarily on the use of ultrasound to postulate key imaging points.

Adnexal torsion can take a subacute, intermittent, or chronic course, which may be challenging to diagnose. Prompt early recognition and operative management of this abnormality is essential. Correct and early diagnosis facilitates prompt surgical exploration to prevent ovarian tissue loss and the consequent effect on future fertility.

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