PMC4896168_01
14-year-old girl with ovarian torsion. Pelvic Sonogram. (A) and (B) Sagittal midline images of the pelvis show a pear-shaped soft tissue structure superior and posterior to the urinary bladder thought to be the uterus with a posterior complex cystic mass with no internal flow by color Doppler exam.
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The interpretation of the US at our institution is offered in Figure 1A-B, Figure 1C-D.
14-year-old girl with ovarian torsion. Pelvic Sonogram. (C) Parasagittal and (D) transverse images of the pelvis show the complex heterogeneous round soft tissue mass with septation.
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CT images (Figure 2) demonstrated a right adnexal non-enhancing mass as well as a small amount of hemoperitoneum.
14-year-old girl with ovarian torsion. (A) Coronal and (B) axial contrast enhanced CT shows agenesis of the left kidney. The left ovary is laterally displaced to the paracolic gutter (arrow). There is a large non enhancing posterior midline pelvic mass, which has caused right lateral displacement of a tubular shaped uterus. The low density material in the endometrial cavity may represent secretory phase endometrium or small amount of intrauterine fluid. The appendix had a normal appearance (not shown).
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MRI was performed. MRI confirmed the presence of the unicornute uterus and a large non contrast-enhancing mass, likely representing a torsed right ovary (Figure 3A, Figure 3B, Figure 3C, Figure 3D).
14-year-old girl with ovarian torsion. Coronal STIR MRI shows a heterogeneous mass with cystic components, which appears distinct from the secretory phase uterus.
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After the ovary was untwisted, it appeared clearly edematous throughout with no obviously viable tissue (Figure 4A). Gross pathological appearance (Figure 4B) and histological findings supported the presence of diffuse hemorrhage in necrotic tissue and the absence of a viable mass in the right ovary and fallopian tube.