Today’s MedCram video explanation comes from our OBGYN and Family Medicine Question Banks and focuses on ovarian torsion. If you’re studying for any of these exams, you may come across this complicated topic. This question frequently trips up our users, so we asked Dr. Roger Seheult from MedCram to help clear up the confusion and break it down for us.
The Question: A 24-year-old female presents to the emergency department with the acute onset of severe right lower quadrant abdominal pain. Her temperature is 98.5 F. She is doubled over in pain and has had 3 episodes of vomiting since the onset of pain 2 hours ago. There is no migration of the patient’s pain. LMP was 2 weeks ago and was normal. She denies any recent urinary discomfort or abnormal vaginal discharge. Rapid urine pregnancy test is negative. What emergent study should be ordered on this patient to confirm the diagnosis?
A. CT scan of abdomen and pelvis with contrast
B. Pelvic ultrasound with doppler flow
E. GC/Chlamydia probe
Correct answer: (B) Pelvic ultrasound with doppler flow.
Explanation: Ovarian torsion is a surgical emergency. Pain is classically acute in onset and severe, often accompanied by vomiting. Torsion occurs when the ovary twists on its pedicle, cutting off blood flow. Pain is caused by ischemia to the ovary. If this is not treated promptly, loss of ovarian function can occur. The most frequent finding on ultrasound is ovarian enlargement. Approximately 50% of women with confirmed adnexal torsion (surgically) will have normal Doppler flow. Abnormal flow is suggestive of ovarian torsion but does not confirm the diagnosis. Acute appendicitis should be in the differential for this patient, but the acute and violent onset of symptoms suggests ovarian torsion. CT scan of the abdomen might show ovarian cyst, but blood flow to the ovary could not be evaluated so torsion could be missed.
Reference: Lobo RA, Gershenson DM, Lentz GM, Valea FA. Comprehensive Gynecology, 7th Edition. Elsevier 2016. Kruszka PS1, Kruszka SJ. Evaluation of acute pelvic pain in women. Am Fam Physician. 2010 Jul 15;82(2):141-7. Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. 2009 Mar;52(1):2-20.