Pediatric Ovarian Torsion: Should You Go With the Flow?

Area of Science:

• Pediatric Emergency Medicine
• Radiology
• Gynecology

Background:

• Ovarian torsion (OT) is a critical surgical emergency requiring prompt diagnosis to prevent adnexal damage.
• Ultrasound is the primary diagnostic tool, with evolving criteria for accuracy.
• Traditionally, Doppler flow was key, but recent research suggests ovarian size is more indicative.

Purpose of the Study:

• To compare the diagnostic accuracy of ovarian size discrepancy versus Doppler flow in pediatric OT.
• To identify distinguishing clinical symptoms of OT in pediatric patients.
• To evaluate ultrasound findings for improved OT diagnosis in the pediatric emergency setting.

Main Methods:

• Retrospective, cross-sectional study of female pediatric patients (1-18 years) undergoing pelvic ultrasound for suspected OT over two years.
• Patient data identified via radiology report analytics.
• Analysis of ovarian size, size discrepancy, Doppler flow, and clinical symptoms.

Main Results:

• A significant difference in ovarian volume (5.57x) was observed in patients with OT compared to those without (1.56x; P < 0.001).
• OT was associated with a 33-fold increased risk of absent arterial flow and a 9-fold increased risk of absent venous flow.
• Emesis, peritoneal signs, and prior OT history were more common in patients with OT; all reported abdominal pain.

Conclusions:

• Large ovarian size discrepancy on ultrasound is a strong indicator of pediatric ovarian torsion.
• Absence of Doppler flow is a significant diagnostic marker for OT, but its presence does not rule out torsion.
• Clinical symptoms for OT remain nonspecific, necessitating reliance on imaging findings.