Dhanda Sunita, Quek Swee T, Ting Mok Y, Rong Clement Y H, Ting Eric Y S, Jagmohan Pooja, Wee Bernard
1 Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
2 Department of Pathology, National University Hospital, Singapore, Singapore.
Br J Radiol. 2017 Oct;90(1078):20170052. doi: 10.1259/bjr.20170052. Epub 2017 Jun 27.
Ovarian torsion is a surgical emergency characterized by a partial or complete rotation of the ovarian vascular pedicle, causing obstruction to venous outflow followed by arterial inflow. Clinically, ovarian torsion frequently mimics other causes of acute pelvic pain such as appendicitis, diverticulitis, renal colic etc. Ultrasonography is the first-line imaging modality of choice for evaluation of ovarian torsion. MRI is useful as a problem-solving tool in patients with equivocal or non-diagnostic ultrasonography studies. CT is ordinarily not utilized in a young female with suspected ovarian torsion due to the radiation dose. However, the significant expansion in use of CT imaging in emergency departments for female patients presenting with acute abdominal pain has increased the likelihood that ovarian torsion may be first seen on CT. In addition, a non-specific clinical presentation may lead to an initial imaging with CT rather than ultrasonography. Ultrasound features of the ovarian torsion are well known and sufficiently described across literature as compared with the CT scan findings. In view of the increasing usage of CT as the modality of choice in emergency settings, it is imperative for the radiologist to familiarize with the CT features of ovarian torsion. An early correct diagnosis by the radiologist in clinically unsuspected cases, facilitating a prompt surgery to restore the ovarian blood flow can prevent permanent irreversible damage. There is limited published data available on the CT features of ovarian torsion. This pictorial essay illustrates CT findings with histological correlation of surgically proven ovarian torsion in our institution. These patients were primarily investigated with CT scan for acute pelvic pain ascribed to non-gynaecological causes such as bowel or urinary tract lesions.
卵巢扭转是一种外科急症，其特征为卵巢血管蒂部分或完全旋转，导致静脉回流受阻，随后动脉血流也受阻。临床上，卵巢扭转常与其他引起急性盆腔疼痛的病因相似，如阑尾炎、憩室炎、肾绞痛等。超声检查是评估卵巢扭转的首选一线影像学检查方法。对于超声检查结果不明确或无法诊断的患者，磁共振成像（MRI）作为一种解决问题的工具很有用。由于辐射剂量的原因，CT通常不用于疑似卵巢扭转的年轻女性。然而，急诊科对出现急性腹痛的女性患者使用CT成像的显著增加，提高了卵巢扭转可能首先在CT上被发现的可能性。此外，非特异性的临床表现可能导致最初进行CT而非超声检查。与CT扫描结果相比，卵巢扭转的超声特征在文献中已有充分描述。鉴于CT在急诊环境中作为首选检查方法的使用越来越多，放射科医生熟悉卵巢扭转的CT特征势在必行。放射科医生在临床未怀疑的病例中早期做出正确诊断，有助于及时进行手术以恢复卵巢血流，从而防止永久性不可逆损伤。关于卵巢扭转的CT特征，已发表的数据有限。这篇图文并茂的文章展示了我院经手术证实的卵巢扭转的CT表现及其组织学相关性。这些患者最初因肠道或泌尿系统病变等非妇科原因导致的急性盆腔疼痛而接受CT扫描检查。
