👩⚕️ Scanning & Imaging Tips: Recognizing Ovarian Torsion

Adnexal torsion may cause ovarian displacement, enlargement, edema, and peripheral follicle displacement, known as the “string of pearls sign” (Chang et al.). The accompanying color Doppler transvaginal ultrasound images demonstrate a torsed right ovary with peripheral follicles and a twisted vascular pedicle, known as the “whirlpool sign.”
Color and pulsed-wave Doppler findings vary with the degree of vascular compromise and may demonstrate reduced or absent arterial and venous flow (Shadinger et al.). Importantly, normal Doppler flow does not exclude ovarian torsion, as the ovary’s dual blood supply or intermittent or partial torsion may preserve arterial perfusion.
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Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med. 2001 Oct;20(10):1083-1089.
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 2008 Sep-Oct;28(5):1355-1368.
Pena JE, Ufberg D, Cooney N, et al. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 2000 May;73(5):1047-1050.
Servaes S, Zurakowski D, Laufer MR, et al. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007 May;37(5):446-451.
Shadinger L, Andreotti R, Kurian R. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med. 2008 Jan;27(1):7-13.