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A 32 yoF with recent fertility treatment presented to the Bay Ridge ED with severe right pelvic pain associated with nausea and vomiting. The transvaginal ultrasound showed:
- Video 1: an enlarged, edematous right ovary with no color flow and free fluid around it
- Video 2: enlarged left ovary but with color flow
- Image 1: venous flow in L ovary
- Image 2: arterial flow in L ovary
The patient was transferred to MMC, where she was seen by GYN and consented for a diagnostic laparotomy. Intraoperatively, the right ovary was noted to be twisted 3 times and was successfully un-twisted.
Note: Fertility treatments can cause ovarian hyperstimulation syndrome (OHSS), where the ovaries become pathologically enlarged due to capillary leak and third spacing of fluid. The increase in ovarian size from OHSS predisposes patients to ovarian torsion.
Note: Ultrasound is not 100% sensitive for torsion. Doppler findings may be normal as the ovary has a dual blood supply (both ovarian and uterine arteries). If you have a high clinical suspicion despite a negative ultrasound, OBGYN should be consulted.
Happy Scanning!
- Ariella Cohen M.D.
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