Gestação heterotópica associada a torção de anexo contralateral em gestação não planejada / Heterotopic management associated with the torment of contralateral apparatus in unplugged management

A gestação heterotópica se define como uma gravidez intra e uma extraútero, nesse caso, a gravidez que se encontra extraútero, em tuba uterina. Foi descoberta após a paciente apresentar dor abdominal, ainda não relatando atraso menstrual e sem a paciente apresentar desejo de engravidar. O diagnóstico foi feito por meio do exame de ultrassonografia com a visualização de massa anexial íntegra à esquerda. A torção de ovário, que é definida pela rotação parcial ou total do pedículo vascular ovariano, causando estase circulatória que pode causar progressivamente edema e gangrena e progredir para necrose, causando danos irreversíveis aos ovários, também foi descoberta por meio do exame de ultrassom e dos sintomas da paciente. A clínica apresentou-se por abdome agudo. No intraoperatório, foi feito o diagnóstico de gestação heterotópica e também apresentou torção de ovário contralateral, caso esse sobre o qual, em conjunto, não há relatos na literatura.(AU)

Heterotopic gestation is defined as an intrauterine pregnancy and an extrauterine pregnancy, in this case the extrauterine pregnancy in the uterine tube. It was discovered after the patient presented abdominal pain, still not reporting menstrual delay and without the patient presenting desire to become pregnant. The diagnosis was made through the ultrasound examination with the visualization of complete adnexal mass on the left. Ovarian torsion, which is defined by partial or total rotation of the ovarian vascular pedicle, causing a circulatory stasis that can progressively cause edema, gangrene and progress to necrosis, causing irreversible damage to the ovaries, was also discovered by ultrasound examination and of the patient's symptoms. The clinic presented with an acute abdomen. n the intraoperative period, the diagnosis of heterotopic gestation was made and also presented contralateral ovary torsion, in which case, there are no reports in the literature.(AU)

Ectopic ovary with torsion: uncommon diagnosis made by ultrasound / Ovário ectópico torcido: diagnóstico incomum definido por ultrassonografia

Abstract Ultrasound is an important diagnostic tool in inguinal hernia and in the evaluation of the contents of the hernia sac. This report presents a case in which ultrasound revealed a herniated ectopic ovary, complicated by torsion of its vascular pedicle, in the right labia majora. We also present a brief discussion of ovarian hernia, its potential complications, and the treatments available.

Resumo A ultrassonografia é uma importante ferramenta diagnóstica no quadro de hérnia inguinal e na avaliação do conteúdo do saco herniário. Neste relato será apresentado um caso com diagnóstico ultrassonográfico de ovário ectópico herniado na região do grande lábio vulvar direito, complicado com torção de seu pedículo vascular, assim como será feita uma breve discussão sobre herniação ovariana, suas complicações e tratamentos.

Utilidad de la ultrasonografía en el diagnóstico de la torsión anexial (TA): revisión / Usefulness of ultrasonography in the diagnosis of adnexal torsion: review

Adnexal torsion is a gynecological emergency caused by the twisting of the ovary on its pedicle, causing lymphatic and venous stasis later in the evolution ischemia and necrosis when left untreated. There is no specific clinical sign or manifestation, nor any sensitive biochemical marker available for diagnosing adnexal torsion or ischemia. The best imaging tool in the diagnosis of torsion is the gynecologic ultrasound. The purpose of this review is to gather the ultrasound signs (coiling, whirlpool, ovary size, Doppler, etc.) found to make the diagnosis of this pathology easier.

La torsión anexial es una emergencia ginecológica causada por la torsión del ovario sobre el pedículo, lo que lleva a estasia linfática y venosa, más tarde en la evolución isquemia y necrosis, cuando no es tradada. No hay signos ni manifestaciones específicas, no hay marcadores bioquímicos para el diagnóstico de torsión anexial o isquemia. La mejor herramienta, en cuanto a exámenes de imágenes, es la ecografía ginecológica. El propósito de esta revisión es recolectar los hallazgos ecográficos (enbobinado, remolino, tamaño ovárico, Doppler, etc.) encontrados en la torsión para hacer más fácil el diagnóstico de esta patología.

Isolated Torsion of Fallopian Tubes: Detection of Pedicle at Tubal End: Two Case Report

Adnexal and ovarian torsion cause acute or chronic abdominal pain, and on ultrasonography, CT and MRI, theradiologic findings of twisted pedicle are clearly demonstrated. Due not only to the rarity of the disease butalso because the symptoms and signs are similar to those seen in cases of adnexal torsion, isolated torsion of thefallopian tubes is not easily diagnosed. The author describes two cases of this condition which on CT andultrasonography showed the "whirling" pattern of twisted pedicle located at the tubal end ; this pattern isassociated with tubal pregnancy or hydrosalpinx. The distal location of twisted pedicle at the fallopian tube,ipsilateral tubal dilatation and ipsilateral normal ovary suggests isolated torsion of the fallopian tubes.

Whirling Sign: An Imaging Finding Indicating Ovarian Torsion

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.

Whirling Sign: An Imaging Finding Indicating Ovarian Torsion

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.

Torsion of Ovarian Tumor: CT Findings

PURPOSE: To evaluate characteristic CT features of twisted ovarian tumors and to assess the diagnostic value of the existence of twisted vascular pedicle in torsion of ovarian tumors. MATERIALS AND METHODS: Weretrospectively reviewed the clinical and CT findings in eleven patients with ovarian tumor torsion confirmed bysurgery. Pre- and post-contrast CT were available in nine patients and post-contrast CT in two. All twisted ovaries, tubes, and tumors showed hemorrhagic infarction and necrosis. RESULTS: All patients had twisted vascular pedicle of the ovarian tumor evaluated by CT. Eight patients with left ovarian tumor had twisted vascular pedicleon the left side of the tumor, and three patients with right ovarian tumor on the right side of the tumor. Themorphologic characteristics of twisted vascular pedicle were coiled target appearance (4 cases), beak appearance(3 cases), doughnut appearance (3 cases), and mass with irregular margin (1 case). High density on precontrast CT scan was present in the pedicle in four cases and linear contrast enhancement was seen in the peripheral portionof the pedicle in four cases. The shape, density and location of ovarian tumors were inconsistent, however, contrast enhancement was not seen in all patients. Other findings were uterine deviation, loss of fat plane andpelvic fluid. CONCLUSION: Detection of twisted vascular pedicle by CT may be useful for the diagnosis of ovariantumor torsion.