Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792, USA.
Radiographics. 2013 Jan-Feb;33(1):155-73. doi: 10.1148/rg.331125016.
Although bowel torsion is more commonly described in the medical literature, torsion can affect various organs within the chest, abdomen, and pelvis, including the testes, ovaries, gallbladder, spleen, heart, and pulmonary lobes. A structural abnormality such as a mass (a "lead point") that promotes twisting around a vascular pedicle often predisposes an organ or other anatomic structure to torsion. Radiologists play a central role in detecting torsion, identifying the anatomy involved, and triaging patients for either emergent surgical intervention, which may be critical for organ salvage, or conservative management. Imaging findings that are suggestive or indicative of emergent torsion include an ectopic location and enlargement or edema of part or all of an organ, decreased blood flow at color Doppler ultrasonography, and a twisted vascular pedicle. Blood flow to an organ is quickly compromised by the constriction of vessels within the twisted pedicle, and ischemia may result; a delay in diagnosis and surgical treatment can lead to complications such as infarction, hemorrhagic necrosis, and abscess. By contrast, torsion of mobile fatty structures such as testicular appendages, epiploic appendages, omental fat, and pericardial fat pads, although it may produce pain mimicking that in an emergent condition, requires only conservative management. Imaging features of this nonemergent condition include a fatty mass, which is usually located alongside the colon when torsion involves the omentum or an epiploic appendage, with associated inflammatory stranding and tenderness at palpation. The radiologist should be familiar with these manifestations of nonemergent torsion to prevent unnecessary surgical intervention.
尽管肠扭转在医学文献中更为常见，但扭转也可能影响胸部、腹部和骨盆内的各种器官，包括睾丸、卵巢、胆囊、脾脏、心脏和肺叶。结构异常（如“铅点”）促进围绕血管蒂扭曲往往使器官或其他解剖结构容易发生扭转。放射科医生在检测扭转、识别涉及的解剖结构以及对患者进行紧急手术干预或保守管理的分类方面发挥着核心作用。提示或提示紧急扭转的影像学发现包括异位位置和部分或全部器官的增大或水肿、彩色多普勒超声检查中血流减少以及扭曲的血管蒂。扭转的血管蒂内血管的收缩迅速限制了器官的血流，可能导致缺血；诊断和手术治疗的延迟可导致梗塞、出血性坏死和脓肿等并发症。相比之下，移动的脂肪结构（如睾丸附件、网膜附件、网膜脂肪和心包脂肪垫）的扭转虽然可能产生类似于紧急情况的疼痛，但只需要保守治疗。这种非紧急情况的影像学特征包括脂肪肿块，当扭转涉及网膜或网膜附件时，通常位于结肠旁边，伴有相关的炎症性条索和触诊时的压痛。放射科医生应熟悉这些非紧急扭转的表现，以防止不必要的手术干预。
