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Feel free to reach out to us for further information!
IAME is accredited by ACCME to provide AMA PRA Category 1 Credit™ for physicians and healthcare professionals.
We operate in North America, Australia, and South Korea.
© 2026 Institute for Advanced Medical Education, All Rights Reserved.
By Institute for Advanced Medical Education
When acute pelvic pain raises concern for ovary torsion, ultrasound is usually the first imaging test. Ovarian torsion (often adnexal torsion) is rotation of the ovary, and frequently the tube, on its ligamentous supports. Venous and lymphatic obstruction occur first. Arterial flow can persist, so a normal arterial waveform does not exclude the diagnosis. The sections below cover grayscale signs, Doppler pitfalls, mimics, and a scanner checklist.
Classic ovarian torsion symptoms are sudden unilateral pelvic pain with nausea and vomiting, but pain can be intermittent. Compare both adnexa, document size and stromal architecture, search for a twisted pedicle, and interpret Doppler in context. Do not discount an enlarged, edematous ovary because arterial flow is present. Imaging supports surgical judgment. It does not replace it.
Compare ovaries with the same probe and depth. Grayscale signs are often more reliable than Doppler.
Useful signs include:
Missing any one sign does not exclude torsion, especially with intermittent symptoms. A hyperechoic follicular rim can support edema.
Dual supply from the ovarian artery and the uterine artery's ovarian branch allows arterial flow to persist after venous obstruction. Intermittent torsion can look normal between pain episodes.
Use transvaginal imaging when appropriate and add transabdominal views for a large mass, a child, or a high ovary. Lower the color scale, consider power Doppler, and sweep from the uterine cornu to the ovary to find the pedicle.
If a mass is the lead point, typical benign versus concerning features still help surgical planning. After you communicate torsion risk, a structured approach to characterizing ovarian masses as benign or malignant is useful.
What causes ovarian torsion is usually a lead-point mass, ovarian enlargement (including after stimulation), pregnancy, prior torsion, or mobile ligaments. A normal ovary can twist, especially in children. Ovarian torsion pain location is typically unilateral lower abdomen or pelvis and may radiate to the back, flank, or groin. There is no validated ovarian torsion pain scale. Ovarian torsion treatment is prompt surgical detorsion, with ovarian conservation preferred when feasible. Delayed ischemia can destroy the ovary. Untreated infarction can lead to peritonitis and, rarely, life-threatening infection. Prevention is limited to cyst management per gynecologic guidance and oophoropexy after recurrent torsion in selected patients.
Accurate, timely ultrasound can shorten time to the operating room. IAME offers accredited ultrasound CME courses on ovarian imaging for clinicians who want a deeper review of adnexal technique and interpretation.
It can if ischemia destroys the ovary or oophorectomy is required, particularly when the other ovary is already compromised. Many patients retain function after prompt detorsion, even if the ovary looks ischemic at surgery.
Gynecologic causes include torsion, hemorrhagic cyst, rupture, ectopic pregnancy, pelvic inflammatory disease, and mittelschmerz. Nongynecologic sources such as appendicitis, ureteral stone, and diverticulitis can produce similar pain, so correlate the ultrasound with the full clinical picture.
Most patients describe sudden, severe unilateral pelvic or lower abdominal pain with nausea and vomiting. Pain may radiate to the back, flank, or groin and can be intermittent if the ovary twists and untwists.
Public descriptions, including those used by the NHS, highlight sudden severe lower abdominal or pelvic pain, often with nausea and vomiting. Pain may come and go, and these symptoms overlap with other emergencies, so they warrant urgent assessment rather than a standalone diagnosis.
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Feel free to reach out to us for further information!
IAME is accredited by ACCME to provide AMA PRA Category 1 Credit™ for physicians and healthcare professionals.
We operate in North America, Australia, and South Korea.
© 2026 Institute for Advanced Medical Education, All Rights Reserved.
