Advertisement

Abdominal Radiology

, Volume 44, Issue 9, pp 3158–3165 | Cite as

Peripheral hypervascularity of the corpus luteum with ovarian edema (CLOE) may decrease false positive diagnoses of ovarian torsion

  • Douglas RogersEmail author
  • Ragheed Al-Dulaimi
  • Maryam Rezvani
  • Anne Kennedy
  • Akram Shaaban
Pelvis

Abstract

Introduction

In patients with pelvic pain, corpus luteum with associated ovarian edema (CLOE) may be mistaken for ovarian torsion on ultrasound or CECT.

Methods

This was a multi-reader, blinded, retrospective review performed at a single academic center from 2012 to 2018. Cases of CLOE that were misdiagnosed as torsion and cases of ovarian torsion without a lead-point mass were analyzed. Evaluated ultrasound features included presence of a corpus luteum, ovarian and corpus luteum volume, Color Doppler vascularity of the corpus luteum rim compared to that of the ovarian stroma, peripheral follicular displacement, twisted vascular pedicle, and free fluid. Evaluated CT features included presence of a corpus luteum, ovarian and corpus luteum volume, corpus luteum rim enhancement, twisted vascular pedicle, and free fluid.

Results

39 cases of CLOE and 30 cases of ovarian torsion without lead-point mass were reviewed. A corpus luteum was present in 56.7% of torsed ovaries. In CLOE cases, peripheral hypervascularity of the corpus luteum (manifested as enhancement at CECT or flow signal at Doppler US) was present in 67.7% (21/31) of cases on ultrasound, and in 95.7% (22/23) of cases on CT. No peripheral hypervascularity of the corpus luteum was seen in cases of torsion (p < 0.001). Torsed ovaries were significantly larger than CLOE cases. Other findings were not significantly different between the two groups.

Conclusion

Increased blood flow in the periphery of a corpus luteum on color Doppler ultrasound or on CECT is a strong negative predictor for ovarian torsion.

Keywords

Corpus luteum Ovarian edema Ovarian torsion Adnexal torsion 

Notes

Compliance with ethical standards

Conflict of interest

This project was IRB reviewed and exempted. No grant money was received for this project. Douglas Rogers, Ragheed Al-Dulaimi, Maryam Rezvani, Anne Kennedy, and Akram Shaaban do not have any conflict of interest to disclose.

References

  1. 1.
    Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J (2018) What every radiologist should know about adnexal torsion. Emerg Radiol 25(1):51–59.CrossRefGoogle Scholar
  2. 2.
    Chang HC, Bhatt S, Dogra VS (2008) Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 28(5):1355–68.CrossRefGoogle Scholar
  3. 3.
    Deuigenan S, Oliva E, Lee S (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 198(2):W122–31.CrossRefGoogle Scholar
  4. 4.
    Umesaki N, Tanaka T, Miyama M, Kawamura N (2000) Sonographic characteristics of massive ovarian edema. Ultrasound Obstet Gynecol 16(5):479–81.CrossRefGoogle Scholar
  5. 5.
    Hall BP, Printz DA, Roth J. Massive ovarian edema: ultrasound and MR characteristics. J Comput Assist Tomogr 1993 May-Jun; 17(3):477–9Google Scholar
  6. 6.
    Machairiotis N, Stylianaki A, Kouroutou P, et al (2016) Massive ovarian oedema: a misleading clinical entity. Diagn Pathol 11:18.CrossRefGoogle Scholar
  7. 7.
    Dalloul M, Sherer DM, Gorelick C, Serur E, Zinn H, Sanmugarajah J, Zigalo A, Abulafia O (2007) Transient bilateral ovarian enlargement associated with large retroperitoneal lymphoma. Ultrasound Obstet Gynecol 29(2):236–8.CrossRefGoogle Scholar
  8. 8.
    Krasevic M, Haller H, Rupcic S, Behrem S (2004) Massive edema of the ovary: a report of two cases due to lymphatic permeation by metastatic carcinoma from the uterine cervix. Gynecol Oncol 93(2):564–7.CrossRefGoogle Scholar
  9. 9.
    Bazot M, Detchev R, Cortez A, Uzan S, Darai E (2003) Massive ovarian edema revealing gastric carcinoma: a case report. Gynecol Oncol 91(3):648–50.CrossRefGoogle Scholar
  10. 10.
    Callen AL, Illangasekare T, Poder L (2017) Massive ovarian edema, due to adjacent appendicitis. Emerg Radiol 24(2):215–218.CrossRefGoogle Scholar
  11. 11.
    Rogers D, Al-Dulaimi R, Rezvani M, Shaaban A (2019) Corpus luteum with ovarian stromal edema is associated with pelvic pain and confusion for ovarian torsion. Abdom Radiol (NY) 44(2):697–704.CrossRefGoogle Scholar
  12. 12.
    Warner MA, Fleischer AC, Edell SL, Thieme GA, Bundy AL, Kurtz AB, James AE Jr (1985) Uterine adnexal torsion: sonographic findings. Radiology 154(3):773–5.CrossRefGoogle Scholar
  13. 13.
    Pena JE, Ufberg D, Cooney N, Denis AL (2000) Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 73(5):1047–50.CrossRefGoogle Scholar
  14. 14.
    Rosado WM Jr, Trambert MA, Gosink BB, Pretorius DH (1992) Adnexal torsion: diagnosis by using Doppler sonography. AJR Am J Roentgenol 159(6):1251–3.CrossRefGoogle Scholar
  15. 15.
    Melcer Y, Maymon R, Pekar-Zlotin M, Vaknin Z, Pansky M, Smorgick N (2018) Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women. Arch Gynecol Obstet 297(3):685–690.CrossRefGoogle Scholar
  16. 16.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–74.CrossRefGoogle Scholar
  17. 17.
    Beyth Y, Klein Z, Tepper R, Weinstein S, Aviram R (2006) Hemorrhagic corpus luteum is associated with ovarian edema. J Pediatr Adolesc Gynecol 19(5):325–7.CrossRefGoogle Scholar
  18. 18.
    Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I (2011) Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med 30(9):1205–10.CrossRefGoogle Scholar
  19. 19.
    Melcer Y, Maymon R, Pekar-Zlotin M, Pansky M, Smorgick N (2018) Clinical and sonographic predictors of adnexal torsion in pediatric and adolescent patients. J Pediatr Surg 53(7):1396–1398.CrossRefGoogle Scholar
  20. 20.
    Huang PH, Tsai KB, Tsai EM, Su JH (2003) Hemorrhagic corpus luteum cyst torsion in term pregnancy: a case report. Kaohsiung J Med Sci 19(2):5–8.CrossRefGoogle Scholar
  21. 21.
    DiLuigi AJ, Maier DB, Benadiva CA (2008) Ruptured ectopic pregnancy with contralateral adnexal torsion after spontaneous conception. Fertil Steril 90(5):2007.e1–3.CrossRefGoogle Scholar
  22. 22.
    Albayram F, Hamper UM (2001) Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 20(10):1083–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology and Imaging SciencesUniversity of Utah Medical CenterSalt Lake CityUSA

Personalised recommendations