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Radiologia 2017Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of...
Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management.
Topics: Acute Pain; Diagnosis, Differential; Emergencies; Endometriosis; Female; Genital Diseases, Female; Humans; Ovarian Cysts; Pelvic Inflammatory Disease; Pelvic Pain; Pregnancy; Pregnancy, Ectopic; Torsion Abnormality
PubMed: 27979433
DOI: 10.1016/j.rx.2016.09.010 -
Emergency Medicine Clinics of North... Nov 2021Abdominal pain is a common reason for emergency department visits, with many patients not receiving a definitive diagnosis for their symptoms. Non-gastrointestinal... (Review)
Review
Abdominal pain is a common reason for emergency department visits, with many patients not receiving a definitive diagnosis for their symptoms. Non-gastrointestinal causes need to be considered in the workup of abdominal pain. A high index of suspicion is needed in order to develop a broad differential, and a thorough history and physical examination is paramount. This article will discuss some of these diagnoses, including can't miss diagnoses, common non-abdominal causes, and rare etiologies of abdominal pain.
Topics: Abdominal Pain; Acute Coronary Syndrome; Adrenal Gland Diseases; Anemia, Sickle Cell; Angioedemas, Hereditary; Aortic Diseases; COVID-19; Diabetic Ketoacidosis; Diagnosis, Differential; Emergency Service, Hospital; Female; Heart Failure; Herpes Zoster; Humans; IgA Vasculitis; Lead Poisoning; Migraine Disorders; Ovarian Torsion; Pelvic Inflammatory Disease; Pneumonia; Porphyria, Acute Intermittent; Pregnancy; Pregnancy, Ectopic; Pulmonary Embolism; Thyrotoxicosis; Uremia
PubMed: 34600641
DOI: 10.1016/j.emc.2021.07.003 -
American Family Physician Apr 2016Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. Women who report abdominal or... (Review)
Review
Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. Pelvic examination has low sensitivity for detecting an adnexal mass; negative pelvic examination findings in a symptomatic woman should not deter further workup. Ectopic pregnancy must be ruled out in women of reproductive age. A cancer antigen 125 (CA 125) test may assist in the evaluation of an adnexal mass in appropriate patients. CA 125 levels are elevated in conditions other than ovarian cancer. Because substantial overlap in CA 125 levels between pre- and postmenopausal women may occur, this level alone is not recommended for differentiating between a benign and a malignant adnexal mass. Transvaginal ultrasonography is the first choice for imaging of an adnexal mass. Large mass size, complexity, projections, septation, irregularity, or bilaterality may indicate cancer. If disease is suspected outside of the ovary, computed tomography may be indicated; magnetic resonance imaging may better show malignant characteristics in the ovary. Serial ultrasonography and periodic measurement of CA 125 levels may help in differentiating between benign or potentially malignant adnexal masses. If an adnexal mass larger than 6 cm is found on ultrasonography, or if findings persist longer than 12 weeks, referral to a gynecologist or gynecologic oncologist is indicated.
Topics: Adnexal Diseases; CA-125 Antigen; Chorionic Gonadotropin, beta Subunit, Human; Diagnosis, Differential; Endometriosis; Female; Gynecological Examination; Humans; Leiomyoma; Magnetic Resonance Imaging; Ovarian Cysts; Ovarian Diseases; Ovarian Neoplasms; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Pregnancy; Pregnancy, Ectopic; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography; Uterine Neoplasms
PubMed: 27175840
DOI: No ID Found -
Ultrasound in Obstetrics & Gynecology :... Dec 2020To describe the clinical and ultrasound characteristics of adnexal torsion.
OBJECTIVES
To describe the clinical and ultrasound characteristics of adnexal torsion.
METHODS
This was a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion, defined as surgical evidence of ovarian pedicle, paraovarian cyst and/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between 2008 and 2018. Only cases with at least two available ultrasound images and/or videoclips (one grayscale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrieved from each patient's medical record and entered into an Excel file by the principal investigator at each center. In addition, two authors reviewed all available ultrasound images and videoclips of the twisted adnexa, with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: (1) ovarian stromal edema with or without peripherally displaced antral follicles, (2) the follicular ring sign, (3) the whirlpool sign and (4) absence of vascularization in the twisted organ.
RESULTS
A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range, 1-88) years. Most patients were premenopausal (284/314; 90.4%) and presented with acute or subacute pelvic pain (305/315; 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting with or without excision of a lesion) was performed in 149/315 (47.3%) cases. According to the original ultrasound reports, the median largest diameter of the twisted organ was 83 (range, 30-349) mm. Free fluid in the pouch of Douglas was detected in 196/275 (71.3%) patients. Ovarian stromal edema with or without peripherally displaced antral follicles was reported in the original ultrasound report in 167/241 (69.3%) patients, the whirlpool sign in 178/226 (78.8%) patients, absent color Doppler signals in the twisted organ in 119/269 (44.2%) patients and the follicular ring sign in 51/134 (38.1%) patients. On retrospective review of images and videoclips, ovarian stromal edema with or without peripherally displaced antral follicles (201/254; 79.1%) and the whirlpool sign (139/153; 90.8%) were the most commonly detected features of adnexal torsion.
CONCLUSION
Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged adnexa, the whirlpool sign, ovarian stromal edema with or without peripherally displaced antral follicles and free fluid in the pelvis. The follicular ring sign and absence of Doppler signals in the twisted organ are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that the correct treatment, i.e. surgery without delay, can be offered. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adnexa Uteri; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Middle Aged; Ovarian Torsion; Pelvic Pain; Retrospective Studies; Ultrasonography, Doppler; Urogenital Abnormalities; Uterus
PubMed: 31975482
DOI: 10.1002/uog.21981 -
Acta Obstetricia Et Gynecologica... Mar 2015The increasing use of de-torsion of the ovaries may result in re-torsion. This review addresses risk of re-torsion and describes preventive strategies to avoid... (Review)
Review
The increasing use of de-torsion of the ovaries may result in re-torsion. This review addresses risk of re-torsion and describes preventive strategies to avoid re-torsion in pre-menarcheal girls, and fertile and pregnant women. We clinically reviewed PubMed, Embase, Trip and Cochrane databases. The main outcome measures were re-torsion and viability of ovary with fixation measures. A total of 38 publications including 71 girls, 363 fertile women, and 69 pregnant women were found to be relevant. All studies were case reports or case series, sometimes with non-randomized controls. The studies show considerable heterogeneity in design, population, management and outcome. Only four studies included more than 50 cases. In pregnancy the risk of re-torsion was as high as 19.5-37.5%; among fertile women it was 28.6%. Most articles concluded that fixation of the ovaries to the pelvic sidewall or plication of the ovarian ligament after torsion may prevent re-torsion. In one case a girl experienced re-torsion after ovariopexy. Based on observational studies it seems that de-torsion and fixation of the ovary is a safe procedure that usually ensures maintenance of ovarian function and reduces the risk of recurrence, especially when there are no ovarian cysts or adnexal masses.
Topics: Adnexal Diseases; Adult; Female; Gynecologic Surgical Procedures; Humans; Ovarian Cysts; Ovary; Pregnancy; Pregnancy Complications; Risk Factors; Torsion Abnormality; Young Adult
PubMed: 25412114
DOI: 10.1111/aogs.12542 -
Ci Ji Yi Xue Za Zhi = Tzu-chi Medical... 2017Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity.... (Review)
Review
Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%-15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
PubMed: 28974907
DOI: 10.4103/tcmj.tcmj_55_17 -
Radiology Case Reports Jul 2021Ovarian torsion (OT) is a medical emergency which can have significant clinical consequences. It is surgically treated by either detorsion with or without oophoropexy,...
Ovarian torsion (OT) is a medical emergency which can have significant clinical consequences. It is surgically treated by either detorsion with or without oophoropexy, or oophorectomy. In this report, a case of left OT is described after prior hysterectomy and bilateral prophylactic oophoropexy three years prior. The patient presented with progressive left flank and abdominal pain. The diagnosis of torsion was made using a combination of CT and MR imaging with confirmation at surgery and pathology. At laparoscopic surgery, the left ovary was found at the level of iliac crest posterior to the descending colon. The ovary was torsed with hemorrhagic infarction. It was successfully removed. The patient was discharged postoperative day one and is now free of symptoms and complaints. OT is rarely reported after hysterectomy and oophoropexy. This case demonstrates that OT should be kept in the differential even in patients post hysterectomy and/or oophoropexy.
PubMed: 34007376
DOI: 10.1016/j.radcr.2021.03.040