A 19-year-old woman has sudden onset severe right iliac fossa pain with vomiting. Transvaginal ultrasound shows a markedly enlarged right ovary measuring 8 cm with multiple peripheral follicles and free fluid in the pouch of Douglas. Which Doppler finding would most strongly support the diagnosis of ovarian torsion?

• A Increased arterial and venous flow within the ovary
• B Absent arterial and venous flow within the ovary ✓
• C Normal ovarian flow but increased uterine artery resistance index
• D Reversed diastolic flow in both uterine arteries

Explanation

Ovarian torsion classically shows an enlarged ovary displaced medially with peripheral follicles and absent internal arterial and venous Doppler flow due to vascular compromise. However, normal flow does not exclude torsion because dual blood supply allows partial or intermittent torsion, so management rests on clinical suspicion. An enlarged ovary with peripheral follicles alone is highly suggestive even when Doppler appears unremarkable.

Reference: Callen's Ultrasonography in Obstetrics and Gynecology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.