Diagnostic ultrasound ( PDFDrive )

CHAPTER 16 The Adnexa 577
PID, ruptured ovarian cyst, and ectopic pregnancy. he most
consistent inding of ovarian torsion is an enlarged edematous
ovary (Fig. 16.13) or ovarian complex of ovary and adnexal mass.
he location of the ovary is frequently medial and superior to
its usual location (Fig. 16.14A). 104 If the fallopian tube is involved,
a hydrosalpinx will usually be demonstrated.
Peripherally placed follicles and homogeneous echoes seen
centrally consistent with areas of edema within enlarged ovaries
have also been reported, 105,106 although these descriptors are
nonspeciic (Video 16.6). Entities such as endometriomas,
polycystic ovaries, hemorrhagic cysts, tubo-ovarian complexes,
and hyperstimulated ovaries undergoing ovulation induction are
oten similarly described. he irregular internal texture of the
ovary seems to correlate with intraovarian hemorrhage. Free
luid within the cul-de-sac is another nonspeciic inding frequently
associated with cases of ovarian torsion. he luid may
be a transudate from the ovarian capsule secondary to obstruction
of veins and lymphatic vessels. 107
FIG. 16.13 Ovarian Torsion: Doppler Evaluation of Enlarged
Ovaries. TVS color Doppler image of a young woman presenting with
acute pelvic pain shows no evidence of color Doppler low within an
enlarged ovary containing irregular parenchyma; low is demonstrated
distally within the iliac artery. See also Video 16.6.
C
B
U
A
B
C
D
FIG. 16.14 Ovarian Torsion With Cyst as Fulcrum. (A) TAS sagittal image of a young woman with acute pain shows a large, simple cyst (C)
that lies anterior to the uterus (U) and cephalad to the bladder (B). This unusual position should raise the suspicion of torsion. (B)-(D) Another
young female patient who is postpartum presenting with acute pelvic pain. (B) TAS shows a large simple ovarian cyst superior to the uterus. (C)
and (D) TAS spectral Doppler images show normal arterial and venous waveforms within the wall of the cyst.