From the Division of Pediatric Emergency Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
Division of Pediatric Emergency Medicine, Department of Pediatrics.
Pediatr Emerg Care. 2022 Jun 1;38(6):e1332-e1335. doi: 10.1097/PEC.0000000000002679. Epub 2022 Feb 28.
Ovarian torsion (OT) is an emergency that mandates early detection and surgical detorsion to avoid catastrophic consequences of further adnexal injury. Prompt ultrasound is critical for accurate diagnosis. Traditionally, evaluation of arterial and venous flow was used as a diagnostic tool for OT, but recent radiologic research has indicated that ovarian size and size discrepancy between sides is a better diagnostic criterion. This study seeks to determine whether ovarian size discrepancy or vascular flow to the ovary is more accurate in the diagnosis of OT in the pediatric emergency population and to better describe symptoms that distinguish OT from other abdominal and pelvic pathology.
This was a retrospective, cross-sectional study evaluating all female pediatric patients, aged 1 to 18 years, who underwent a pelvic ultrasound to evaluate for OT over a 2-year period in our pediatric emergency department. Patients suitable for inclusion were identified via Nuance mPowerTM, a search engine that provides clinical analytics based on radiology reports generated within our institution.
We reviewed the medical records of 193 female patients aged 1 to 18 years, all of whom had a pelvic ultrasound (with or without Doppler) to evaluate for OT during the study period. In comparing ovarian size on ultrasound, patients with OT had a significantly larger magnitude of difference in ovarian volume than patients without torsion (5.57× [interquartile range, 3-12.5] vs 1.56× [interquartile range, 1.24-2.25; P < 0.001]). Ovarian torsion was associated with a 33-fold increased risk of lack of arterial flow (relative risk, 33.33) and with a 9-fold increased risk of lack of venous flow (relative risk, 9.27), when compared with those patients without OT. Patients with OT were significantly more likely to have emesis and peritoneal signs on examination, as well as previous history of OT (P = 0.01, 0.02, and 0.002, respectively) than those without OT. All patients with OT reported abdominal pain.
We found that a large size discrepancy between ovaries is indicative of OT. Our data also suggest that presence of Doppler flow on ultrasound cannot be used to exclude OT but that lack of Doppler flow on ultrasound is a significant diagnostic marker. As previous studies have also found, clinical symptoms of OT are nonspecific and do not offer any certainty in differentiating OT from other pathologies.
卵巢扭转（OT）是一种急症，需要早期发现和手术松解，以避免附件进一步损伤的灾难性后果。及时进行超声检查对于准确诊断至关重要。传统上，评估动脉和静脉血流被用作诊断 OT 的工具，但最近的放射学研究表明，卵巢大小和两侧大小差异是更好的诊断标准。本研究旨在确定在儿科急诊人群中，卵巢大小差异或卵巢血管血流对 OT 的诊断更准确，并更好地描述区分 OT 与其他腹部和盆腔病变的症状。
这是一项回顾性、横断面研究，评估了在我们的儿科急诊部门进行骨盆超声检查以评估 OT 的 2 年间所有 1 至 18 岁的女性儿科患者。通过 Nuance mPowerTM 识别适合纳入的患者，该搜索引擎根据我们机构生成的放射学报告提供临床分析。
我们回顾了 193 名 1 至 18 岁女性患者的病历，所有患者均行盆腔超声（有或无多普勒）检查以评估 OT。在比较卵巢大小的超声结果时，OT 患者的卵巢体积差异明显大于无扭转患者（5.57×[四分位距，3-12.5]比 1.56×[四分位距，1.24-2.25；P<0.001]）。与无 OT 患者相比，OT 患者动脉血流缺失的风险增加 33 倍（相对风险，33.33），静脉血流缺失的风险增加 9 倍（相对风险，9.27）。与无 OT 患者相比，OT 患者更有可能出现呕吐和腹膜征，以及有 OT 病史（P=0.01、0.02 和 0.002）。所有 OT 患者均报告有腹痛。
我们发现卵巢大小差异较大提示 OT。我们的数据还表明，超声检查中存在多普勒血流不能排除 OT，但超声检查中缺乏多普勒血流是一个重要的诊断标志物。与之前的研究一样，OT 的临床症状也不特异，不能确定 OT 与其他病变的区别。
