Hyde Hannah,  Tutman Jeffrey,  Blanco Ernesto

Final Pr. ID: Poster #: CR-015

Ovarian torsion is a very rare occurrence where the ovary becomes twisted, cutting off blood supply, and placing the ovary at risk of tissue death and loss of function. Appendicitis, although more common in the pediatric population, is still a relatively uncommon condition that can have grave consequences. Appendicitis secondary to ovarian torsion, in the instance where the ovary twists on its peduncle around the body of the appendix, is not only extremely rare, but puts the patient at risks for complications and consequences for both of these rare issues. This case report will tell the story of a 15-year-old girl including her initial presentation, clinical details, imaging, post-operative notes, and prognosis. Although a very atypical finding, this case highlights the importance of time and the particular dangers when dealing with two very critical diagnoses. Read More

Authors:  Hyde Hannah , Tutman Jeffrey , Blanco Ernesto

Keywords:  Appendicitis, Torsion, Ovary

Veale Simone,  Choudhary Arabinda,  Kecskemethy Heidi,  Gould Sharon

Final Pr. ID: Poster #: SCI-013

This retrospective pilot study was performed to assess the utility of limited protocol MRI for appendicitis in excluding ovarian torsion by assessing ovarian symmetry with regard to size and appearance comparing torsed cases to controls. Read More

Authors:  Veale Simone , Choudhary Arabinda , Kecskemethy Heidi , Gould Sharon

Keywords:  Ovary, Torsion, MRI

Wanous Amanda,  Monahan Hannah,  Javed Asma

Final Pr. ID: Poster #: SCI-013

Accurate diagnosis of Polycystic Ovary syndrome (PCOS) in adolescents relies on clinical, biochemical and radiographic criteria. The traditionally utilized Rotterdam criteria define polycystic ovarian morphology (PCOM) as the presence of 12 or more follicles, measuring 2-9 mm in either ovary and/or an ovarian volume >10 cm³. Due to advancement in imaging techniques and resolution, it has been proposed by the Androgen Excess Society Taskforce to update criteria for diagnosis of PCOM to presence of 25 or more follicles per ovary. The aim of this study was to correlate the diagnosis of PCOM using ovarian volume and follicle number criteria in adolescents with confirmed PCOS based on NIH criteria. The NIH criteria are stringent and require the presence of both menstrual irregularity and clinical or biochemical evidence of hyperandrogenism for a diagnosis of PCOS. Read More

Authors:  Wanous Amanda , Monahan Hannah , Javed Asma

Keywords:  Ultrasound, Ovary, Adolescent

Burgos Daylen Sire,  Park Halley

Final Pr. ID: Poster #: CR-009

An 8-year-old female with Poland syndrome of the left chest initially presents to be considered for reconstructive surgery. On the preoperative MRI, along with the expected hypoplastic left hemithorax including the ribs, pectoralis major, and minor muscles, there is the absence of a left ovary in the pelvis and left kidney. Furthermore, there is an incidental 9 mm multicystic structure at the anterior spleen. No further workup was done at that time. After undergoing reconstructive surgery as well as scoliosis, occasional chest pain is experienced 10 years later. During the clinical workup, incidentally noted on the CT chest with contrast is increased anterior splenic hypodensity. The possibility for ectopic ovary or splenogonadal fusion was raised as well as involuted or atrophic multicystic dysplastic kidney, neoplasm, or vascular malformation.
Initial workup included the US which revealed a 3.3 cm nonspecific lesion with posterior acoustic enhancement and without substantial internal vascularity. MRI of the spleen was performed which revealed a multicystic lesion, with imaging characteristics highly suggestive of an ectopic left ovary containing multiple physiologic follicles, from splenogonadal fusion. The uterus is also noted to be a right-sided unicornuate uterus. Furthermore, tiny non-communicative cystic changes in a linear manner left lateral to the psoas muscle, were identified, which may represent involuted/atretic remnant of the left multicystic dysplastic kidney. Read More

Authors:  Burgos Daylen Sire , Park Halley

Keywords:  Ectopic, Ovary, splenogonadal

Otjen Jeffrey,  Stanescu A. Luana,  Parisi Marguerite

Final Pr. ID: Poster #: SCI-052

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. Read More

Authors:  Otjen Jeffrey , Stanescu A. Luana , Parisi Marguerite

Keywords:  Medialization, Ovary, Torsion, Ultrasound

Alturkistani Tahani,  Levin Terry,  Kurian Jessica,  Mazzariol Fernanda

Final Pr. ID: Poster #: EDU-031

1.To review the embryology of female genital system.
2.To define Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) and atypical MRKH, also called MURCS(Müllerian aplasia, unilateral renal agenesis and anomalies of the cervico-thoracic somites).
3.To discuss the imaging findings and clinical management of classic MRKH and contrast it to MURCS.
4.To discuss the rare association of MRKH and MURCS with gonadal dysgenesis/agenesis. US and MR were evaluated to determine efficacy of identifying adnexae. Read More

Authors:  Alturkistani Tahani , Levin Terry , Kurian Jessica , Mazzariol Fernanda

Keywords:  Gonadal dysgenesis, MRKH syndrome, MURCS, streak ovaries

Otjen Jeffrey,  Ansdell David,  Stanescu A. Luana,  Alessio Adam,  Parisi Marguerite

Final Pr. ID: Poster #: SCI-024

Ultrasound has long been a readily available, noninvasive, and accurate means of evaluating the female pelvis and is widely used in the emergency setting for girls with abdominal and pelvic pain. One key element in evaluating for pathology is to measure ovarian size and compare left and right ovaries. Normative volume data stratified by age are available; however, these studies suffer from lack of numbers, and frequently older equipment. Technological advances in ultrasonic hardware and software have increased the resolution of both gray-scale and Doppler imaging. Increases in spatial resolution allow for better identification and measurement of ovaries and precise measurements and depictions of anatomic details. The purpose of this study was to re-evaluate normal pediatric ovarian volumes in relation to patient age with a larger dataset and newer technology. Read More

Authors:  Otjen Jeffrey , Ansdell David , Stanescu A. Luana , Alessio Adam , Parisi Marguerite

Keywords:  Ovary, Ultrasound

Cullen Thomas,  Seekins Jayne,  Halabi Safwan

Final Pr. ID: Poster #: EDU-048

The development and migration of reproductive organs is a complex process that is often poorly understood. Abnormally located testes and ovaries may reflect an incidental transient finding or underlying/pending pathology. Cryptorchidism is the most common genitourinary anomaly in males with associated increased risk of infertility and malignancy. Ectopic testes (outside the normal line of descent) have been reported within the perineum, penis, and femoral canal, representing a rare- but important entity to recognize and diagnose. Abnormally positioned ovaries- either in the midline pelvis or within the canal of Nuck- may mimic tumors or reflect underlying vascular compromise of the tissue.

This educational exhibit will present a case-based review of the normal migration and anatomic position of gonadal tissue, as well as common and uncommon aberrant locations. In addition, this exhibit will highlight imaging strategies, including appropriate modalities and techniques. A brief discussion of current concepts in management will also be provided. Read More

Authors:  Cullen Thomas , Seekins Jayne , Halabi Safwan

Keywords:  Cryptorchidism, reproductive, testes, ovaries, gonads

Dorai Raju Anand,  Chauhan Ankita,  Cohen Harris

Final Pr. ID: Poster #: EDU-027

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.
Read More

Authors:  Dorai Raju Anand , Chauhan Ankita , Cohen Harris

Keywords:  Torsion, Adnexa, ovary, fallopian tube