I'm looking for for ultrasound sign of ovarian torsion?
Ovarian torsion usually presents in the first three decades of life and is predisposed in patients with co-existing ovarian pathology such as follicular cyst. There may be history of similar episodes indicating intermittent torsion and spontaneous detorsion. Torsion causes venous outflow obstruction and engorgement of the ovary. Eventually arterial supply is compromised and necrosis ensues. Diagnosis is suggested by unilateral enlargement of a round or oval-shaped ovary containing multiple enlarged peripheral cysts (caused by transudation of fluid into follicles). Free fluid is present in the majority of cases. Peripheral blood flow may be present but may be absent with infarction. Ovarian hyperstimulation can present with abdominal pain and may show an enlarged multicystic ovary associated with ascites. However, the condition usually arises from ovarian hormone stimulation in the setting of infertility. Polycystic ovary syndrome typically presents with menstrual disturbance, obesity and hyperandrogenism. (Ref: Bates p. 85)
with the help of a 7.5 MHz transdur (endorectal) in case of cows and buffaloes, we may find anechoic follicles with static doppler effect (blood flow will be occluded). the history of the animal will be repeat breeding. but its very rare condition in cows/ buffaloes
Ultrasound is the imaging modality of choice. Sonographic features include:
enlarged hypo or hyperechoic ovary
peripherally displaced follicles with hyperechoic central stroma
midline ovary
free pelvic fluid: may be seen in >80% of cases
an underlying ovarian lesion may be seen (possible lead point for torsion)
a long-standing infarcted ovary may have a more complex appearance with cystic or haemorrhagic degeneration
Doppler findings in torsion can be widely variable 3 little or no intra-ovarian venous flow (common)
absent arterial flow (less common, but poor prognostic sign)
absent or reversed diastolic flow
normal vascularity does not exclude intermittent torsionnormal Doppler flow can also occasionally be found due to dual supply from both the ovarian and uterine arteries
whirlpool sign of twisted vascular pedicle 3
The ovary should be tender to transducer pressure Courtesy Radiopedia
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