Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging
Abstract Background The torsion of normal adnexa is rare during pregnancy, especially in the third trimester. Nonspecific symptoms and signs as well as the limitations of ultrasound (US) make the diagnosis difficult, resulting in the loss of adnexa and fetal compromise. The magnetic resonance imagin...
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doaj-aed3394795b841c6bc55504e4e6fda902020-11-25T03:48:43ZengBMCBMC Medical Imaging1471-23422020-02-012011510.1186/s12880-020-00422-1Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imagingWei Bai0Xiao Xu1Haizhu Xie2Chunjuan Sun3Kaili Che4Meijie Liu5Jing Liu6Yinghong Shi7Heng Ma8Yuhuangding Hospital, Qingdao University School of MedicineWeifang Medical UniversityYuhuangding Hospital, Qingdao University School of MedicineYuhuangding Hospital, Qingdao University School of MedicineYuhuangding Hospital, Qingdao University School of MedicineBinzhou Medical UniversityYuhuangding Hospital, Qingdao University School of MedicineYuhuangding Hospital, Qingdao University School of MedicineYuhuangding Hospital, Qingdao University School of MedicineAbstract Background The torsion of normal adnexa is rare during pregnancy, especially in the third trimester. Nonspecific symptoms and signs as well as the limitations of ultrasound (US) make the diagnosis difficult, resulting in the loss of adnexa and fetal compromise. The magnetic resonance imaging (MRI) features of the torsion of normal adnexa are not classically described during pregnancy and only reported in a few cases. We find some different MRI features of the torsion of normal adnexa in late pregnancy and its diagnosis and treatment values are discussed in our report. Case presentation A 27-year-old woman at 31 + 5 weeks’ gestation presented to the emergency department with a three-day history of the left lower abdominal pain. US discovered a mass of 87 × 61 mm in the left abdomen, but did not show whether the mass originated from the left ovary or the uterus. MRI showed the left ovary was increased in size to 82 × 42 × 85 mm with peripheral follicles. On fat-suppressed T2-weighted images, the signal intensity of the lesion was significantly decreased compared with the right ovary. The adjacent fallopian tube was found to be thickened. The radiologists diagnosed ovary infarction secondary to adnexal torsion. With the provisional diagnosis of adnexal torsion, the patient was taken to surgery. The left adnexal torsion was found during surgery. There was extensive hemorrhage and necrosis, so a left salpingo-oophorectomy was performed. The histopathology confirmed an extensively hemorrhagic fallopian tube and ovary with partial necrosis. Conclusion We believe MRI is helpful where US is indeterminate in diagnosis of the torsion of normal adnexa in advanced pregnancy. We found that aside from hyperintensity on fat-saturated T1-weighted images, the low signal intensity on T2-weighted images can also reflect adnexal hemorrhage in conjunction with the torsion of normal adnexa.http://link.springer.com/article/10.1186/s12880-020-00422-1Adnexal torsionMagnetic resonance imagingPregnancyThird trimester |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Wei Bai Xiao Xu Haizhu Xie Chunjuan Sun Kaili Che Meijie Liu Jing Liu Yinghong Shi Heng Ma |
spellingShingle |
Wei Bai Xiao Xu Haizhu Xie Chunjuan Sun Kaili Che Meijie Liu Jing Liu Yinghong Shi Heng Ma Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging BMC Medical Imaging Adnexal torsion Magnetic resonance imaging Pregnancy Third trimester |
author_facet |
Wei Bai Xiao Xu Haizhu Xie Chunjuan Sun Kaili Che Meijie Liu Jing Liu Yinghong Shi Heng Ma |
author_sort |
Wei Bai |
title |
Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging |
title_short |
Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging |
title_full |
Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging |
title_fullStr |
Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging |
title_full_unstemmed |
Adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of MR imaging |
title_sort |
adnexal torsion in the third trimester of pregnancy: a case report and diagnostic value of mr imaging |
publisher |
BMC |
series |
BMC Medical Imaging |
issn |
1471-2342 |
publishDate |
2020-02-01 |
description |
Abstract Background The torsion of normal adnexa is rare during pregnancy, especially in the third trimester. Nonspecific symptoms and signs as well as the limitations of ultrasound (US) make the diagnosis difficult, resulting in the loss of adnexa and fetal compromise. The magnetic resonance imaging (MRI) features of the torsion of normal adnexa are not classically described during pregnancy and only reported in a few cases. We find some different MRI features of the torsion of normal adnexa in late pregnancy and its diagnosis and treatment values are discussed in our report. Case presentation A 27-year-old woman at 31 + 5 weeks’ gestation presented to the emergency department with a three-day history of the left lower abdominal pain. US discovered a mass of 87 × 61 mm in the left abdomen, but did not show whether the mass originated from the left ovary or the uterus. MRI showed the left ovary was increased in size to 82 × 42 × 85 mm with peripheral follicles. On fat-suppressed T2-weighted images, the signal intensity of the lesion was significantly decreased compared with the right ovary. The adjacent fallopian tube was found to be thickened. The radiologists diagnosed ovary infarction secondary to adnexal torsion. With the provisional diagnosis of adnexal torsion, the patient was taken to surgery. The left adnexal torsion was found during surgery. There was extensive hemorrhage and necrosis, so a left salpingo-oophorectomy was performed. The histopathology confirmed an extensively hemorrhagic fallopian tube and ovary with partial necrosis. Conclusion We believe MRI is helpful where US is indeterminate in diagnosis of the torsion of normal adnexa in advanced pregnancy. We found that aside from hyperintensity on fat-saturated T1-weighted images, the low signal intensity on T2-weighted images can also reflect adnexal hemorrhage in conjunction with the torsion of normal adnexa. |
topic |
Adnexal torsion Magnetic resonance imaging Pregnancy Third trimester |
url |
http://link.springer.com/article/10.1186/s12880-020-00422-1 |
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