Acute pelvic pain (female), suspected ovarian torsion
Recommended: Pelvic Ultrasound with Doppler is the preferred imaging study for acute pelvic pain (female), suspected ovarian torsion. Surgical emergency.
Recommended study
Pelvic Ultrasound with Doppler
Surgical emergency. Pelvic US ± Doppler. Note: Doppler can be normal in intermittent torsion — proceed to surgery if high suspicion regardless.
If the default doesn't apply
US equivocal and intermediate suspicion
MRI
MRI Pelvis
IV contrast
Watch-outs
Normal Doppler does not exclude torsion
Intermittent torsion may show preserved flow between episodes — proceed to laparoscopy if high clinical suspicion.
Pediatric ovarian torsion
Often missed; consider in young girls with acute abdominal/pelvic pain even without an apparent mass.
Pearls
- Enlarged ovary (> 4 cm) with peripheral follicles is the most reliable US finding.
- Whirlpool sign in the adnexa indicates twisted vascular pedicle.
- Most torsions occur in ovaries with a lead point (dermoid, functional cyst, hyperstimulated ovary).