Pediatric Ovarian Torsion: Spectrum of Imaging Findings

The accurate diagnosis of ovarian torsion is imperative, as loss of the ovary can have long-term consequences in terms of fertility. However, a nonspecific clinical presentation in conjunction with a highly variable imaging appearance makes the diagnosis of ovarian torsion challenging. This is complicated even further in the pediatric population, as these patients cannot always articulate their symptoms or provide an adequate medical history. Therefore, imaging has a critical role in the diagnosis of ovarian torsion in pediatric patients. Common imaging findings of ovarian torsion in the prepubescent and adolescent populations include asymmetric enlargement of the ovary, peripheral location of ovarian follicles, and midline location of the ovary. A coexistent mass within the ovary may or may not be present. Antenatal torsion also can occur and may be discovered at routine or specific imaging of the fetus or postnatal imaging of the neonate. Imaging findings in the perinatal population that may suggest torsion include a cystic mass with a fluid-debris level and a complex, multiseptated mass. This article reviews ovarian torsion throughout the pediatric years-from the fetal period through adolescence. It reviews the clinical presentation and imaging findings of this abnormality while describing the relevant anatomy, embryologic features, and pathophysiology. Ovarian torsion may be variable in appearance owing to the age and degree of torsion, which is seen early as a large ovary with peripheral follicles and later, once necrosis has ensued, as a complex cystic mass. RSNA, 2017.