Unveiling the Unseen: CT's Crucial Role in Detecting Ovarian Torsion
Unseen to the naked eye, ovarian torsion can be a life-threatening condition. But here's where it gets controversial... According to a recent study presented at the Royal Australian and New Zealand College of Radiologists (RANZCR) meeting, Computed Tomography (CT) imaging plays a pivotal role in identifying this condition, which is often missed due to its nonspecific symptoms.
Dr. Azri Johari, from the radiology department of Mackay Hospital and Health Services in Queensland, Australia, highlighted the importance of recognizing the signs of ovarian torsion on CT scans. Ovarian torsion, a twisting of the ovarian vascular pedicle, accounts for approximately 2.7% to 3% of all acute abdominal pain presentations in women. Its symptoms can mimic other conditions like appendicitis or renal colic, making diagnosis challenging and potentially leading to delayed treatment.
While Doppler ultrasound is the primary diagnostic tool, it has technical limitations, especially in ambiguous cases. CT, on the other hand, has demonstrated remarkable sensitivity and specificity for ovarian torsion, ranging from 74% to 95% and 80% to 90%, respectively, when characteristic features are present. This is in contrast to ultrasound's sensitivity and specificity of 80% and 88%.
The case series presented by Dr. Johari and colleagues not only reinforces the importance of cross-sectional imaging in emergency settings but also emphasizes the need to recognize key CT features of ovarian torsion. In both cases, CT imaging revealed crucial signs, such as large ovarian cystic masses and the 'whirlpool sign,' which facilitated timely surgical intervention and treatment. These findings underscore the critical role CT plays in the time-sensitive diagnosis of ovarian torsion.
And this is the part most people miss... While the symptoms of ovarian torsion can vary, both patients in the study presented nonspecific clinical findings with persistent pain. This led to contrast-enhanced CT exams of the abdomen and pelvis, which revealed the key features necessary for diagnosis and treatment.
One patient, a 25-year-old woman, presented with right-sided tenderness and pain, nausea, and vomiting over two days. The other patient, a 37-year-old woman, experienced left-sided tenderness and pain that had persisted for four days. Both patients were hemodynamically stable and afebrile, with normal lab markers. Large ovarian cystic masses were present in both cases, a known risk factor for ovarian torsion.
In the first case, CT imaging showed a large right-sided adnexal cystic mass with evidence of a twisted vascular pedicle, referred to as the 'whirlpool sign.' The second case also revealed a large lesion originating from a left-sided pedicle. These findings highlight the importance of CT in identifying ovarian torsion, even in the absence of specific symptoms.
To learn more about the key CT features of ovarian torsion and the importance of cross-sectional imaging in emergency settings, read the full poster here: https://epos.myesr.org/poster/esr/ranzcr2025/C-183. The poster is available on the EPOS section for the RANZCR ASM 2025, accessible on the European Society of Radiology's website.
Now it's your turn to weigh in. Do you agree with the study's findings? Or do you have a different perspective? Share your thoughts in the comments below!
