Imaging description

A two-month-old girl presented with fussiness and a tender mass located in the left labia majora. A longitudinal ultrasound (US) of the labial mass revealed an enlarged hypoechoic left ovary with multiple peripheral enlarged follicles (Fig. 72.1). The labial location suggested herniation of the ovary into a patent pouch of peritoneum known as the canal of Nuck. Irreducibility along with the abnormal appearance of the ovary and absent venous waveforms with bidirectional arterial flow still present on Doppler US suggested incarceration of the herniated ovary and partial rather than complete ovarian torsion (Fig. 72.1b). Transverse views demonstrated a normal right ovary of smaller size (Fig. 72.1c). Surgical intervention confirmed the diagnosis of partial torsion, with successful detorsion and hernia repair.

Importance

Ovarian torsion is a rare though serious cause of abdominal pain in female children. Delayed diagnosis and treatment is common because of non-specific symptoms and can lead to necrosis and loss of the ovary, resulting in decreased fertility. Due to the higher incidence of functional ovarian cysts as well as pregnancy, girls entering their reproductive years are at greatest risk. However, even infants can present with torsion, especially if a large ovarian tumor or cystic mass initiates twisting of the vascular pedicle.