Fluid-debris level in follicular cysts: a pathognomonic sign of ovarian torsion

Early diagnosis of ovarian torsion is mandatory to avoid common complications. Sonography is the imaging modality of choice, but diagnosis is still a challenge. To report an additional sonographic feature of ovarian torsion in order to improve diagnostic accuracy. Grey-scale and colour Doppler pelvic sonography was performed in 12 patients with acute onset of intermittent lower abdominal pain and in 1 asymptomatic patient with a palpable mass in the labium majus. Patient ages ranged from 4 months to 17 years. In all patients an enlarged ovary with peripheral cysts was demonstrated. High-resolution sonography detected fluid-debris levels within these cystic structures in 11 of the 13 patients (sensitivity 85%) and provided an additional diagnostic sign. Six patients had cystic teratoma. We confirm the fluid-debris level as a pathognomonic sonographic sign of ovarian torsion with or without associated teratoma.