What is the role of Doppler flow studies in the evaluation of ovarian torsion?

Updated: Jun 27, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Auslender et al suggested a classification of severity of adnexal torsion and treatment strategy that was based on blood flow as depicted on Doppler ultrasonography. [25] In their small study (n=17), they used Doppler and gray-scale ultrasonography to visualize coiling of the ovarian vessels, concluding that when coiling of the ovarian vessels is present, Doppler flow examination of the ovary can help differentiate between ischemic adnexal torsion and coiling of the ovarian blood vessels without strangulation, thus facilitating the choice of treatment. [25]

In 9 of these 17 patients, arterial and venous blood flow was present within the ovary, and ultrasonographic and surgical findings usually demonstrated normal-sized or mildly enlarged ovaries; in 5, only arterial blood flow was detected within the ovary, and surgery usually revealed enlarged ovaries with normal color or mild discoloration; and in 3, neither arterial nor venous blood flow was seen within the ovary, vessel coiling was evident only on gray-scale and not on Doppler examination, and signs of ovarian ischemia or necrosis were found at surgery. [25]

In a study of 39 patients by Shadinger et al, ovarian enlargement and the absence of ovarian venous Doppler flow were the most frequent sonographic indications of ovarian torsion. Frequent clinical symptoms included abdominal pain and vomiting. The authors concluded that ovarian torsion should be strongly suspected in the presence of ovarian enlargement and clinical symptoms, even if arterial and venous Doppler flow are present. [30]


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