A 16-year-old girl has sudden severe right iliac pain with vomiting. Ultrasound shows an enlarged right ovary with peripheralised follicles and free fluid. Colour Doppler demonstrates normal arterial and venous flow within the ovary. What is the correct interpretation?

• A Torsion is excluded by the presence of flow
• B Torsion is possible because dual arterial supply can preserve demonstrable flow ✓
• C The findings indicate haemorrhagic corpus luteum instead
• D Normal flow indicates a malignant ovarian tumour

Explanation

The ovary receives arterial supply from both the ovarian artery and the ovarian branch of the uterine artery via the broad ligament anastomosis, so torsion can occlude one source while colour Doppler still demonstrates flow. Diagnosis therefore rests on morphology, an enlarged ovary with peripheral displaced follicles, combined with clinical features. Absence of venous flow supports torsion, but present flow never excludes it, and laparoscopy decides.

Reference: Rumack's Diagnostic Ultrasound, 5th ed.

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