Pediatric Radiology

, Volume 37, Issue 5, pp 446–451 | Cite as

Sonographic findings of ovarian torsion in children

  • Sabah Servaes
  • David Zurakowski
  • Marc R. Laufer
  • Neil Feins
  • Jeanne S. Chow
Original Article



The clinical diagnosis of ovarian torsion is challenging and findings on pelvic sonography can be pivotal in making the correct diagnosis.


To determine the sonographic characteristics in children of surgically and pathologically proven ovarian torsion.

Material and methods

We performed a retrospective review of the sonograms and medical records of 41 patients with surgically and pathologically proven ovarian torsion at a pediatric hospital between 1994 and 2005. All sonograms were reviewed retrospectively by two pediatric radiologists with attention to the size, echotexture, location, presence of peripheral round cysts, and evidence of flow on Doppler sonography within the torsed ovary. The amount of free pelvic fluid was also recorded.


The most common sonographic finding of ovarian torsion was an enlarged ovary/adnexal mass. All torsed adnexa were larger than the normal contralateral ovary, with the median volume 12 times that of the normal contralateral side. The majority (61%, n = 25) of the torsions occurred on the right. Color flow, either venous or arterial, was present in 62% (n = 21/34) of the torsed ovaries for which flow on Doppler sonography was documented. In 63% of the torsed ovaries (n = 26), the torsed adnexa appeared heterogeneous. Ovarian or para-ovarian pathology that may have acted as a potential lead point was present in 55% (n = 24) of torsed ovaries. The volume ratio of the torsed to normal ovary can predict the presence of an ovarian mass within the torsed ovary. In 70% of torsed ovaries with a volume ratio greater than 20, an ovarian mass was present, and in approximately 90% of those with a volume ratio less than 20, an internal mass was absent.


An enlarged heterogeneous appearing ovary is the most common finding in ovarian torsion. The presence or absence of flow by Doppler sonography is not helpful in the diagnosis. The volume ratio of the torsed to the normal ovary can predict the presence of an internal mass within the torsed adnexa.


Ovarian torsion Ovarian mass Pediatric 



We are grateful for the work of Rhonda Johnson and Juliet Palinkas. We also thank Dr. Robert Lebowitz for his suggestions and insightful comments.


  1. 1.
    Descargues G, Tinlot-Mauger F, Gravier A et al (2001) Adnexal torsion: a report on forty-five cases. Eur J Obstet Gynecol Reprod Biol 98:91–96PubMedCrossRefGoogle Scholar
  2. 2.
    Graif M, Itzchak Y (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR 150:647–649PubMedGoogle Scholar
  3. 3.
    Farrell TP, Boal DK, Teele RL et al (1982) Acute torsion of normal uterine adnexa in children: sonographic demonstration. AJR 139:1223–1225PubMedGoogle Scholar
  4. 4.
    Evans JP (1978) Torsion of the normal uterine adnexa in premenarchal girls. J Pediatr Surg 13:195–196PubMedCrossRefGoogle Scholar
  5. 5.
    Schultz LR, Newton WA Jr, Clatworthy HW Jr (1963) Torsion of previously normal tube and ovary in children. N Engl J Med 268:343–346PubMedCrossRefGoogle Scholar
  6. 6.
    Haller JO, Bass IS, Friedman AP (1984) Pelvic masses in girls: an 8-year retrospective analysis stressing ultrasound as the prime imaging modality. Pediatr Radiol 14:363–368PubMedCrossRefGoogle Scholar
  7. 7.
    Orsini LF, Salardi S, Pilu G et al (1984) Pelvic organs in premenarcheal girls: real-time ultrasonography. Radiology 153:113–116PubMedGoogle Scholar
  8. 8.
    Garel L, Dubois J, Grignon A et al (2001) US of the pediatric female pelvis: a clinical perspective. Radiographics 21:1393–1407PubMedGoogle Scholar
  9. 9.
    Nichols DH, Julian PJ (1985) Torsion of the adnexa. Clin Obstet Gynecol 28:375–380PubMedCrossRefGoogle Scholar
  10. 10.
    Warner MA, Fleischer AC, Edell SL et al (1985) Uterine adnexal torsion: sonographic findings. Radiology 154:773–775PubMedGoogle Scholar
  11. 11.
    Graif M, Shalev J, Strauss S et al (1984) Torsion of the ovary: sonographic features. AJR 143:1331–1334PubMedGoogle Scholar
  12. 12.
    Kayaba H, Tamura H, Shirayama K et al (1996) Hemorrhagic ovarian cyst in childhood: a case report. J Pediatr Surg 31:978–979PubMedCrossRefGoogle Scholar
  13. 13.
    Groeber WR (1963) Ovarian tumors during infancy and childhood. Am J Obstet Gynecol 86:1021–1035PubMedGoogle Scholar
  14. 14.
    Kiechl-Kohlendorfer U, Maurer K, Unsinn KM et al (2006) Fluid-debris level in follicular cysts: a pathognomonic sign of ovarian torsion. Pediatr Radiol 36:421–425PubMedCrossRefGoogle Scholar
  15. 15.
    Helvie MA, Silver TM (1989) Ovarian torsion: sonographic evaluation. J Clin Ultrasound 17:327–332PubMedCrossRefGoogle Scholar
  16. 16.
    Fleischer AC, Stein SM, Cullinan JA et al (1995) Color Doppler sonography of adnexal torsion. J Ultrasound Med 14:523–528PubMedGoogle Scholar
  17. 17.
    Pena JE, Ufberg D, Cooney N et al (2000) Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 73:1047–1050PubMedCrossRefGoogle Scholar
  18. 18.
    Rosado WM Jr, Trambert MA, Gosink BB et al (1992) Adnexal torsion: diagnosis by using Doppler sonography. AJR 159:1251–1253PubMedGoogle Scholar
  19. 19.
    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 32:586–588PubMedCrossRefGoogle Scholar
  20. 20.
    Quillin SP, Siegel MJ (1994) Transabdominal color Doppler ultrasonography of the painful adolescent ovary. J Ultrasound Med 13:549–555PubMedGoogle Scholar
  21. 21.
    Stark JE, Siegel MJ (1994) Ovarian torsion in prepubertal and pubertal girls: sonographic findings. AJR 163:1479–1482PubMedGoogle Scholar
  22. 22.
    Tepper R, Zalel Y, Goldberger S et al (1996) Diagnostic value of transvaginal color Doppler flow in ovarian torsion. Eur J Obstet Gynecol Reprod Biol 68:115–118PubMedCrossRefGoogle Scholar
  23. 23.
    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 17:83–89PubMedGoogle Scholar
  24. 24.
    Vijayaraghavan SB (2004) Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 23:1643–1649, quiz 1650–1651PubMedGoogle Scholar
  25. 25.
    Yaman C, Ebner T, Jesacher K (2002) Three-dimensional power Doppler in the diagnosis of ovarian torsion. Ultrasound Obstet Gynecol 20:513–515PubMedCrossRefGoogle Scholar
  26. 26.
    Case records of the Massachusetts General Hospital (1971) Weekly clinicopathological exercises. Case 9-1971. N Engl J Med 284:491–496Google Scholar
  27. 27.
    Feins NR (1991) Torsion of the ovary. In: Grosfeld JL (ed) Common problems in pediatric surgery. Mosby Year Book, St. Louis, pp 100–103Google Scholar
  28. 28.
    Baltarowich OH, Kurtz AB, Pasto ME et al (1987) The spectrum of sonographic findings in hemorrhagic ovarian cysts. AJR 148:901–905PubMedGoogle Scholar
  29. 29.
    Warner BW, Kuhn JC, Barr LL (1992) Conservative management of large ovarian cysts in children: the value of serial pelvic ultrasonography. Surgery 112:749–755PubMedGoogle Scholar
  30. 30.
    Kokoska ER, Keller MS, Weber TR (2000) Acute ovarian torsion in children. Am J Surg 180:462–465PubMedCrossRefGoogle Scholar
  31. 31.
    Mordehai J, Mares AJ, Barki Y et al (1991) Torsion of uterine adnexa in neonates and children: a report of 20 cases. J Pediatr Surg 26:1195–1199PubMedCrossRefGoogle Scholar
  32. 32.
    Ein SH, Darte JM, Stephens CA (1970) Cystic and solid ovarian tumors in children: a 44-year review. J Pediatr Surg 5:148–156PubMedCrossRefGoogle Scholar
  33. 33.
    Helmrath MA, Shin CE, Warner BW (1998) Ovarian cysts in the pediatric population. Semin Pediatr Surg 7:19–28PubMedGoogle Scholar
  34. 34.
    Benjapibal M, Boriboonhirunsarn D, Suphanit I et al (2000) Benign cystic teratoma of the ovary: a review of 608 patients. J Med Assoc Thai 83:1016–1020PubMedGoogle Scholar
  35. 35.
    Lee CH, Raman S, Sivanesaratnam V (1989) Torsion of ovarian tumors: a clinicopathological study. Int J Gynaecol Obstet 28:21–25PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Sabah Servaes
    • 1
    • 5
  • David Zurakowski
    • 1
    • 2
  • Marc R. Laufer
    • 3
  • Neil Feins
    • 4
  • Jeanne S. Chow
    • 1
  1. 1.Department of RadiologyChildren’s Hospital BostonBostonUSA
  2. 2.Department of Orthopedic SurgeryChildren’s Hospital BostonBostonUSA
  3. 3.Department of Surgery, Division of GynecologyChildren’s Hospital BostonBostonUSA
  4. 4.Department of SurgeryChildren’s Hospital BostonBostonUSA
  5. 5.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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