Livingston Joshua K, Gonzales Savannah, Langdorf Mark I
University of California, Irvine, Department of Emergency Medicine, Orange, California.
Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology, Los Angeles, California.
Clin Pract Cases Emerg Med. 2021 Nov;5(4):468-469. doi: 10.5811/cpcem.2021.7.53317.
A 28-year-old female presented to the emergency department complaining of right lower abdominal pain. A contrast-enhanced computed tomography (CT) was done, which showed a 15-centimeter right adnexal cyst with adjacent "whirlpool sign" concerning for right ovarian torsion. Transvaginal pelvic ultrasound (US) revealed a hemorrhagic cyst in the right adnexa, with duplex Doppler identifying arterial and venous flow in both ovaries. Laparoscopic surgery confirmed right ovarian torsion with an attached cystic mass, and a right salpingo-oophorectomy was performed given the mass was suspicious for malignancy.
Ultrasound is the test of choice for diagnosis of torsion due to its ability to evaluate anatomy and perfusion. When ovarian pathology is on the patient's right, appendicitis is high in the differential diagnosis, and CT may be obtained first. Here we describe a case where CT first accurately diagnosed ovarian torsion by demonstrating the whirlpool sign, despite an US that showed arterial flow to the ovary. Future studies should determine whether CT alone is sufficient to diagnose or exclude ovarian torsion.
一名28岁女性因右下腹痛就诊于急诊科。进行了增强计算机断层扫描（CT），结果显示右侧附件有一个15厘米的囊肿，伴有相邻的“漩涡征”，提示右侧卵巢扭转。经阴道盆腔超声（US）显示右侧附件有一个出血性囊肿，双功多普勒检查显示双侧卵巢均有动脉和静脉血流。腹腔镜手术证实为右侧卵巢扭转并伴有一个附着的囊性肿物，鉴于该肿物怀疑为恶性，遂进行了右侧输卵管卵巢切除术。
超声因其能够评估解剖结构和血流灌注，是诊断扭转的首选检查方法。当卵巢病变位于患者右侧时，阑尾炎在鉴别诊断中可能性较大，可能首先进行CT检查。在此我们描述了一个病例，尽管超声显示卵巢有动脉血流，但CT通过显示漩涡征首先准确诊断了卵巢扭转。未来的研究应确定单独使用CT是否足以诊断或排除卵巢扭转。
