EURORAD ESR

Case 14633

Ovarian torsion secondary to a fibroma

Author(s)
Gisela Rio1; Marta Sousa 2; Carlos André Oliveira1; Pedro da Silva Oliveira1

1Braga Hospital
2Entre Douro e Vouga Hospital
 
Patient
female, 18 year(s)
 
 
  • Figure 1
    Unenhanced CT
     

    Unenhanced axial (a) and coronal (b) CT showing a solid mass in the midline, posteriorly to the bladder, and a small amount of free fluid in the pelvic cavity.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Education; Special Focus: Acute;

    Unenhanced axial (a) and coronal (b) CT showing a solid mass in the midline, posteriorly to the bladder, and a small amount of free fluid in the pelvic cavity.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 2
    Ultrasound

    Ultrasound demonstrating a 9 cm solid, hypoechogenic mass, localised in the hypogastrium. There were no signs of appendicitis. The right ovary was morphologically normal, but the left ovary couldn't be clearly...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 3
    T2WI MRI
     

    Sagittal (a) and coronal (b) T2WI showing an amorphous tubular mass-like structure in continuity with the left ovary, corresponding to the thickened and oedematous Fallopian tube (*). Note the ipsilateral uterine...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;

    Sagittal (a) and coronal (b) T2WI showing an amorphous tubular mass-like structure in continuity with the left ovary, corresponding to the thickened and oedematous Fallopian tube (*). Note the ipsilateral uterine...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 4
    Sagittal MRI
     

    Sagittal T2WI showing a tumour arising from the left ovary, which demonstrates increased signal intensity on T2WI due to oedema (arrow), and a follicle within. Note the ascites in the pelvis.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;

    Post-gadolinium T1FS demonstrated poor enhancement of the left ovary (arrow), specially when compared to the right ovary (Fig.5), which is one of the signs of ovarian torsion.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 5
    Sagittal MRI
     

    Sagittal T2WI (a) and post-gadolinium T1FS (b) showing normal morphology and follicular architecture of the right ovary (arrow), with normal enhancement after gadolinium administration.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;

    Sagittal T2WI (a) and post-gadolinium T1FS (b) showing normal morphology and follicular architecture of the right ovary (arrow), with normal enhancement after gadolinium administration.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 6
    Post-gadolinium sagittal T1FS MRI

    Post-gadolinium sagittal T1FS didn't demonstrate the typical whirlpool sign, but engorgement of the vessels around the left tube could be seen, another non-specific sign of torsion.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;
     
     
  • Figure 7
    MRI on the axial plane
     

    The tumour shows low signal intensity on T1WI (a) and very low signal intensity on T2WI (b), compatible with a benign tumour.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;

    Fig. 7- The tumor shows low signal intensity on T1WI (a) and very low signal intensity on T2WI (b), compatible with a benign tumor.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;

    Fig. 7c- On post-contrast T1FS there is mild and relatively homogeneous enhancement, suggesting a fibroma.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Education; Special Focus: Acute;
     
     
Unenhanced axial (a) and coronal (b) CT showing a solid mass in the midline, posteriorly to the bladder, and a small amount of free fluid in the pelvic cavity.
 
Unenhanced axial (a) and coronal (b) CT showing a solid mass in the midline, posteriorly to the bladder, and a small amount of free fluid in the pelvic cavity.
 
Ultrasound demonstrating a 9 cm solid, hypoechogenic mass, localised in the hypogastrium. There were no signs of appendicitis. The right ovary was morphologically normal, but the left ovary couldn't be clearly individualised.
 
Sagittal (a) and coronal (b) T2WI showing an amorphous tubular mass-like structure in continuity with the left ovary, corresponding to the thickened and oedematous Fallopian tube (*). Note the ipsilateral uterine deviation (b).
 
Sagittal (a) and coronal (b) T2WI showing an amorphous tubular mass-like structure in continuity with the left ovary, corresponding to the thickened and oedematous Fallopian tube (*). Note the ipsilateral uterine deviation (b).
 
Sagittal T2WI showing a tumour arising from the left ovary, which demonstrates increased signal intensity on T2WI due to oedema (arrow), and a follicle within. Note the ascites in the pelvis.
 
Post-gadolinium T1FS demonstrated poor enhancement of the left ovary (arrow), specially when compared to the right ovary (Fig.5), which is one of the signs of ovarian torsion.
 
Sagittal T2WI (a) and post-gadolinium T1FS (b) showing normal morphology and follicular architecture of the right ovary (arrow), with normal enhancement after gadolinium administration.
 
Sagittal T2WI (a) and post-gadolinium T1FS (b) showing normal morphology and follicular architecture of the right ovary (arrow), with normal enhancement after gadolinium administration.
 
Post-gadolinium sagittal T1FS didn't demonstrate the typical whirlpool sign, but engorgement of the vessels around the left tube could be seen, another non-specific sign of torsion.
 
The tumour shows low signal intensity on T1WI (a) and very low signal intensity on T2WI (b), compatible with a benign tumour.
 
Fig. 7- The tumor shows low signal intensity on T1WI (a) and very low signal intensity on T2WI (b), compatible with a benign tumor.
 
Fig. 7c- On post-contrast T1FS there is mild and relatively homogeneous enhancement, suggesting a fibroma.
 
 
 
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