[size=6]A 14-year-old girl presents with sudden onset right lower quadrant pain, nausea, and vomiting. She has right lower quadrant tenderness and fullness in the suprapubic area. An ultrasound is obtained. The most likely diagnosis is

 

 

a Ruptured appendicitis with abscess

 

b Ruptured ovarian cyst

 

c Ovarian torsion

 

d Acute appendicitis

 

e Simple ovarian cyst

[/size]

C

C

[size=6]A 14-year-old girl presents with sudden onset right lower quadrant pain, nausea, and vomiting. She has right lower quadrant tenderness and fullness in the suprapubic area. An ultrasound is obtained. The most likely diagnosis is

 

[ATTACH type=full" width="305px" alt="repview.jpeg]15038[/ATTACH][ATTACH type=full" width="287px" alt="repview (1).jpeg]15037[/ATTACH]

 

a Ruptured appendicitis with abscess

 

b Ruptured ovarian cyst

 

c Ovarian torsion

 

d Acute appendicitis

 

e Simple ovarian cyst[/size]

 

A

C

C

[size=6]A 14-year-old girl presents with sudden onset right lower quadrant pain, nausea, and vomiting. She has right lower quadrant tenderness and fullness in the suprapubic area. An ultrasound is obtained. The most likely diagnosis is

 

[ATTACH type=full" width="305px" alt="repview.jpeg]15038[/ATTACH][ATTACH type=full" width="287px" alt="repview (1).jpeg]15037[/ATTACH]

 

a Ruptured appendicitis with abscess

 

b Ruptured ovarian cyst

 

c Ovarian torsion

 

d Acute appendicitis

 

e Simple ovarian cyst[/size]

 

c

C

correct answer

c Ovarian torsion

 

Prompt interpretation of ultrasound imaging is crucial in diagnosing and guiding the therapy of patients with ovarian torsion. There are several features on ultrasound that increase the likelihood of torsion as diagnosis. These include a size discrepancy between the ovaries of greater than twice the volume, ovarian heterogeneity, medialization of the ovary, and peripheralization of follicles. In premenarchal patients, the presence of cysts or masses increase the likelihood of ovarian torsion. Absence of arterial flow color Doppler and whirlpool sign are not always seen in patients with torsion, but are pathognomonic when present. Studies have shown that a combination of these characteristics is more predictive of torsion than any one feature alone.

 

 

Figure above shows ovarian heterogeneity (arrow reflects heterogeneity of ovary).

 

[color=rgb(226, 80, 65)][b][/b][/color]

Figure above shows peripheralization of follicles (arrows reflect the follicles).