Woman with Acute abdomen

Saturday, September 10, 2011
A 22-year old woman was admitted for acute pain in the right lower abdominal quadrant. Laboratory analysis showed mild leukocytosis and slight elevation of C-reactive protein. Transvaginal sonography revealed a complex right adnexal mass and a moderate amount of fluid in the Douglas pouch. A pelvic MR study was indicated.





T2-weighted MR Images are shown here.What is the most likely diagnosis?

ANSWER

Adnexal torsion with haemorrhagic infarction

Transverse T2-weighted image. Tube thickening (arrow) is detected as an amorphous solid masslike structure. A small amount of fluid (long arrow) in the Douglas space is seen.

Sagittal T2-weighted image depicts a few small cystic structures (small arrows) in the periphery of the enlarged adnexa, probably related to transudation of fluid into the ovarian follicles due to ovarian congestion.
Imaging findings were strongly suggestive of hemorrhagic necrosis of the adnexa following torsion and were confirmed surgically.

Adnexal torsion is a rare cause of lower abdominal pain, often presenting as a diagnostic problem due to the nonspecific clinical, laboratory and sonographic findings, as it was seen also in this patient.It is associated with an ipsilateral ovarian tumour or cyst in 50-81% of cases, which is almost always benign.
The sonographic findings of adnexal torsion are usually nonspecific and include the presence of a cystic, solid or complex adnexal mass, as it was seen in this patient.Free intraperitoneal fluid is found in one to two thirds of patients. CT and MR imaging is usually recommended in subacute or chronic cases to confirm the diagnosis of adnexal torsion and to differentiate haemorrhagic from nonhaemorrhagic infarction.Common CT and MR imaging findings of adnexal torsion include fallopian tube thickening, ascites and uterus deviation to the twisted side.Imaging findings suggestive of haemorrhagic infarction include eccentric smooth wall thickening exceeding 10 mm in a cystic ovarian mass, lack of contrast enhancement of the internal solid component or the thickened wall of a twisted adnexal mass, haemorrhage within the tube or adnexal mass, or haemoperitoneum.

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10 comments

  1. Anonymous Says:
  2. Ectopic pregnancy...

     
  3. Ectopic pregnancy

     
  4. Anonymous Says:
  5. BHCG? Ectopic pregnancy.

     
  6. Anonymous Says:
  7. ovarian torsion

     
  8. Anonymous Says:
  9. ovarian torsion

     
  10. Anonymous Says:
  11. PID

     
  12. abdalla Says:
  13. Torsion Ovarian cyst

     
  14. ectopic pregnancy loss

     
  15. most probably the mass is account of inflammatory response to an underlying infection,most probably an acute one
    most probably its an bacterial infection as leucocytosis presnt
    as CRP increased ,hence inflammation should be ruled in
    hence PID

     
  16. Chan Says:
  17. Chocolate cyst

     

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