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CT Features of Adnexal Torsion

Nurith Hiller1, Liat Appelbaum1, Natalia Simanovsky1, Ahinoam Lev-Sagi2, Dvora Aharoni3 and Tamar Sella1

1 Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12227, Jerusalem, Israel, 91121.
2 Department of Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
3 Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.


Figure 1
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  		Fig. 1 —26-year-old woman with torsion of right ovarian dermoid. Unenhanced CT scan shows well-defined fat-containing mass (M) to left of uterus (U). Uterus is deviated to right. Infiltration of fat (arrow) anterior to twisted mass is evident. Pathologic examination revealed necrosis.

 

Figure 2
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  		Fig. 2A —58-year-old woman with torsion of left adnexa manifesting as left flank pain. Contrast-enhanced CT scan (A) and transabdominal sonogram (B) show large midline well-defined cystic mass with thickening of posterior wall (straight arrow, A) and internal septations (curved arrows). Pathologic examination revealed necrotic adnexa with no underlying tumor.

 

Figure 3
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  		Fig. 2B —58-year-old woman with torsion of left adnexa manifesting as left flank pain. Contrast-enhanced CT scan (A) and transabdominal sonogram (B) show large midline well-defined cystic mass with thickening of posterior wall (straight arrow, A) and internal septations (curved arrows). Pathologic examination revealed necrotic adnexa with no underlying tumor.

 

Figure 4
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  		Fig. 3 —41-year-old woman with left adnexal torsion. Contrast-enhanced CT scan shows abnormally located left ovary (LO) on contralateral side of pelvis in far posterior location. Ipsilateral fallopian tube (arrow) is distended. Right ovary (asterisk) is in normal position. Uterus (U) is deviated anteriorly. At surgery, ovary and fallopian tube were found to be torsed, and underlying mass was found. Pathologic examination revealed necrotic cystadenofibroma of ovary.

 

Figure 5
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  		Fig. 4 —42-year-old woman with torsion of right ovary manifesting as chronic right lower abdominal pain that gradually increased in severity. Contrast-enhanced CT scan shows enlarged right cystic ovary (RO) crossing midline of pelvis anterior to uterus (U). Spiral appearance of adnexal vascular pedicle (arrow) is whirl sign. Pathologic examination revealed serous cystadenoma without necrosis.

 

Figure 6
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  		Fig. 5 —50-year-old woman with torsion of left adnexa manifesting as acute left abdominal pain. Contrast-enhanced CT scan shows left ovarian mass (LO) crossing midline to right side. Twisted vascular pedicle and dilated fallopian tube (arrow) are evident to left of mass. Uterus (U) is deviated to side of torsed adnexa. Right ovary, which contains small simple cyst (asterisk), is in normal location. At surgery, ovary and fallopian tube were found to be torsed, and underlying mass was found. Pathologic examination revealed necrosis of left ovary and fallopian tube with ovarian mucinous cystadenoma.

 

Figure 7
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  		Fig. 6 —20-year-old woman with acute lower abdominal pain. Contrast-enhanced CT scan shows torsion of left ovary (LO) in right side of pelvis. Right ovary (RO) is in normal location, and uterus (U) is markedly deviated to involved left side. Mild fat stranding (arrow) anterior to torsed ovary is evident. Pathologic examination revealed necrotic adnexa with no underlying mass. B = bladder.

 

Figure 8
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  		Fig. 7 —49-year-old woman with torsion of right ovary manifesting as subacute right lower abdominal pain. Contrast-enhanced CT scan shows enlarged myomatous uterus (U). Right ovary is in normal position but is cystic in appearance with plasma-erythrocyte level (straight arrow) suggestive of internal hemorrhage. Thickened twisted pedicle (curved arrow) is posterior to mass. Pathologic examination revealed torsed right ovary with hemorrhagic necrosis.

 

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