EURORAD ESR

Case 9280

Adnexal torsion: contribution of MR imaging in diagnosis

Author(s)
Tsili AC1, Maria I. Argyropoulou MI1, Paschopoulos M2, Batistatou A3, Plachouras I2, Tsampoulas K1

(1)Department of Clinical Radiology
(2)Department of Obstetrics & Gynaecology
(3)Department of Pathology
University Hospital of Ioannina, Ioannina, Greece.
 
Patient
female, 22 year(s)
 
 
  • Figure 1
    Figure 1
     

    Transverse T1-weighted image shows right adnexal enlargement, with the presence of a cystic mass (asterisk), detected of low signal intensity. The ipsilateral fallopian tube (arrow) is thickened, and slightly...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;

    Transverse T2-weighted image. Right adnexal mass (asterisk) is of cystic nature, hypointense and hyperintense on T1 and T2-weighted images, respectively. A small amount of fluid (long arrow) in the peritoneum is seen.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;

    Transverse T2-weighted image. Tube thickening (arrow) is detected as an amorphous solid masslike structure. A small amount of fluid (long arrow) in the Douglas space is seen.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;

    Sagittal T2-weighted image depicts a few small cystic structures (small arrows) in the periphery of the enlarged adnexa, probably related to transudation of fluid into the ovarian follicles due to ovarian congestion.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;

    Coronal T2-weighted image shows uterus deviation to the right side (arrow). The right adnexa is located mainly to the left of the midline. Normal left ovary (small arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;

    Transverse ADC map. Acute haemorrhage in the fallopian tube causes dramatic signal drop (arrow), due to T2* effect. The ADC values of the cystic component (asterisk) were 3.37 x 10-3 mm2/second.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Abscess delineation;

    Transverse post-contrast fat-saturated T1-weighted image demonstrates lack of enhancement by the right adnexa and the cystic mass (asterisk), indicating interruption of blood flow. Peritoneal enhancement (arrow) is...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;

    Sagittal post-contrast fat-saturated T1-weighted image demonstrates lack of enhancement by the right adnexa and the cystic mass (asterisk).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR;
     
     
  • Figure 2
    Figure 2

    Laparoscopic image depicts the enlarged, necrotic adnexa.

     
    Area of Interest: Genital / Reproductive system female; Procedure: Surgery;
     
     
  • Figure 3
    Figure 3
     

    Microscopic section of the fallopian tube (H-E X100). Extensive dilatation and congestion of the blood vessels, as well as hemorrhagic infiltration of the wall is noted.

     
    Area of Interest: Genital / Reproductive system female;

    Microscopic section of the cyst (H-E X100). The cyst wall is lined by a single layer of flat cells, without complex architectural pattern or cytologic atypia. There is extensive hemorrhagic infiltration and edema.

     
    Area of Interest: Genital / Reproductive system female;
     
     
Transverse T1-weighted image shows right adnexal enlargement, with the presence of a cystic mass (asterisk), detected of low signal intensity. The ipsilateral fallopian tube (arrow) is thickened, and slightly hyperintense.
 
Transverse T2-weighted image. Right adnexal mass (asterisk) is of cystic nature, hypointense and hyperintense on T1 and T2-weighted images, respectively. A small amount of fluid (long arrow) in the peritoneum is seen.
 
Transverse T2-weighted image. Tube thickening (arrow) is detected as an amorphous solid masslike structure. A small amount of fluid (long arrow) in the Douglas space is seen.
 
Sagittal T2-weighted image depicts a few small cystic structures (small arrows) in the periphery of the enlarged adnexa, probably related to transudation of fluid into the ovarian follicles due to ovarian congestion.
 
Coronal T2-weighted image shows uterus deviation to the right side (arrow). The right adnexa is located mainly to the left of the midline. Normal left ovary (small arrow).
 
Transverse ADC map. Acute haemorrhage in the fallopian tube causes dramatic signal drop (arrow), due to T2* effect. The ADC values of the cystic component (asterisk) were 3.37 x 10-3 mm2/second.
 
Transverse post-contrast fat-saturated T1-weighted image demonstrates lack of enhancement by the right adnexa and the cystic mass (asterisk), indicating interruption of blood flow. Peritoneal enhancement (arrow) is detected.
 
Sagittal post-contrast fat-saturated T1-weighted image demonstrates lack of enhancement by the right adnexa and the cystic mass (asterisk).
 
Laparoscopic image depicts the enlarged, necrotic adnexa.
 
Microscopic section of the fallopian tube (H-E X100). Extensive dilatation and congestion of the blood vessels, as well as hemorrhagic infiltration of the wall is noted.
 
Microscopic section of the cyst (H-E X100). The cyst wall is lined by a single layer of flat cells, without complex architectural pattern or cytologic atypia. There is extensive hemorrhagic infiltration and edema.
 
 
 
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