Describe what ovarian torsion will appear as sonographically? Include patient symptoms.

• A. Enlarged, heterogeneous ovary with nausea and ipsilateral lower abdominal pain
• B. Normal-size ovary with simple cyst
• C. Small ovary with homogeneous echotexture
• D. Ovarian mass with ascites

Answer: (C)

Ovarian torsion twists the ovarian vascular pedicle, leading to acute ischemia and edema of the ovary. On ultrasound the classic clue is an enlarged, edematous ovary, often with a heterogeneous or mildly echogenic stroma and peripheral small follicles pushed to the outer rim. Free pelvic fluid may be present. Doppler blood flow can be decreased or absent, though normal flow does not completely rule out torsion because the ovary has dual blood supply. Clinically, patients typically have sudden, unilateral lower quadrant or pelvic pain with nausea and sometimes vomiting. The description of a small ovary with homogeneous echotexture does not fit torsion well, and normal-size ovaries or simple cysts with ascites point away from torsion as the primary diagnosis.