Skip to main content
SpringerLink
Log in

US findings of adnexal torsion in children and adolescents: size really does matter

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Adnexal torsion is rare, and symptoms are nonspecific. Clinicians often rely on US examinations to evaluate girls with abdominal or pelvic pain.

Objective

To determine which sonographic findings can predict adnexal torsion by comparing pediatric and adolescent patients with surgically confirmed torsion (cases) to those without torsion (controls).

Materials and methods

Cases and controls were identified retrospectively by searching 7 years of medical record and radiology databases. An adnexal ratio was calculated as the volume of the affected adnexa divided by the volume of the unaffected adnexa.

Results

We identified 61 menarchal subjects: 33 cases and 28 controls. Adnexal volume was larger in cases than in controls (185 vs. 37.8 ml, P < 0.001). A volume of >75 ml was more common in cases than in controls (64 vs. 15%, P < 0.001). No cases had an adnexal volume of <20 ml (P < 0.001). The adnexal ratio was larger in cases than in controls (16.1 vs. 6.7, P < 0.001). An adnexal ratio of >15 was seen in 40% of cases and in no controls (P = 0.08). Doppler US results were not predictive of torsion.

Conclusion

An adnexal volume of <20 ml is strong evidence against adnexal torsion in menarchal females. In this age group, the diagnosis of torsion cannot be established by US examination alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Siegel MJ, Carel C, Surratt S (1991) Ultrasonography of acute abdominal pain in children. JAMA 266:1987–1989

    Article  PubMed  CAS  Google Scholar 

  2. Rosado WM Jr, Trambert MA, Gosink BB et al (1992) Adnexal torsion: diagnosis by using Doppler sonography. AJR 159:1251–1253

    PubMed  Google Scholar 

  3. Hurh PJ, Meyer JS, Shaaban A (2002) Ultrasound of a torsed ovary: characteristic gray-scale appearance despite normal arterial and venous flow on Doppler. Pediatr Radiol 32:586–588

    Article  PubMed  Google Scholar 

  4. Ben-Ami M, Perlitz Y, Haddad S (2002) The effectiveness of spectral and color Doppler in predicting ovarian torsion. A prospective study. Eur J Obstet Gynecol Reprod Biol 104:64–66

    Article  PubMed  Google Scholar 

  5. Lee EJ, Kwon HC, Joo HJ et al (1998) Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med 17:83–89

    PubMed  CAS  Google Scholar 

  6. Vijayaraghavan SB (2004) Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 23:1643–1649, quiz 1650–1651

    PubMed  Google Scholar 

  7. Graif M, Itzchak Y (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR 150:647–649

    PubMed  CAS  Google Scholar 

  8. Graif M, Shalev J, Strauss S et al (1984) Torsion of the ovary: sonographic features. AJR 143:1331–1334

    PubMed  CAS  Google Scholar 

  9. Kiechl-Kohlendorfer U, Maurer K, Unsinn KM et al (2006) Fluid-debris level in follicular cysts: a pathognomonic sign of ovarian torsion. Pediatr Radiol 36:421–425

    Article  PubMed  Google Scholar 

  10. Stark JE, Siegel MJ (1994) Ovarian torsion in prepubertal and pubertal girls: sonographic findings. AJR 163:1479–1482

    PubMed  CAS  Google Scholar 

  11. Servaes S, Zurakowski D, Laufer MR et al (2007) Sonographic findings of ovarian torsion in children. Pediatr Radiol 37:446–451

    Article  PubMed  Google Scholar 

  12. Orsini LF, Salardi S, Pilu G et al (1984) Pelvic organs in premenarchal girls: real-time ultrasonography. Radiology 153:113–116

    PubMed  CAS  Google Scholar 

  13. Rody A, Jackisch C, Klockenbusch W et al (2002) The conservative management of adnexal torsion – a case-report and review of the literature. Eur J Obstet Gynecol Reprod Biol 101:83–86

    Article  PubMed  CAS  Google Scholar 

  14. Cil AP, Akgul MA, Tulunay G et al (2006) Recovery of ovarian function after detorsion: Doppler findings. Acta Radiol 47:618–620

    Article  PubMed  CAS  Google Scholar 

  15. Bellah RD, Rosenberg HK (1991) Transvaginal ultrasound in a children’s hospital: is it worthwhile? Pediatr Radiol 21:570–574

    Article  PubMed  CAS  Google Scholar 

  16. Bulas DI, Ahlstrom PA, Sivit CJ et al (1992) Pelvic inflammatory disease in the adolescent: comparison of transabdominal and transvaginal sonographic evaluation. Radiology 183:435–439

    PubMed  CAS  Google Scholar 

  17. Leibman AJ, Kruse B, McSweeney MB (1988) Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses. AJR 151:89–92

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cincinnati Children’s Hospital Medical Center, Department of Radiology, University of Cincinnati School of Medicine, Cincinnati, OH, 45229, USA

    Leann E. Linam & Sara M. O’Hara

  2. Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC, USA

    Renuka Darolia

  3. Department of Radiology, Akron Children’s Hospital, Akron, OH, USA

    Lena N. Naffaa

  4. Department of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA

    Lesley L. Breech, Paula J. Hillard & Jill S. Huppert

Authors
  1. Leann E. Linam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renuka Darolia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lena N. Naffaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lesley L. Breech
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara M. O’Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paula J. Hillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jill S. Huppert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leann E. Linam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Linam, L.E., Darolia, R., Naffaa, L.N. et al. US findings of adnexal torsion in children and adolescents: size really does matter. Pediatr Radiol 37, 1013–1019 (2007). https://doi.org/10.1007/s00247-007-0599-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-007-0599-6

Keywords

Search

Navigation