Ovarian torsion

  • Ovarian torsion usually presents in the first three decades of life and is predisposed in patients with co-existing ovarian pathology such as follicular cyst. 
  • There may be history of similar episodes indicating intermittent torsion and spontaneous detorsion.
  • Torsion causes venous outflow obstruction and engorgement of the ovary. Eventually arterial supply is compromised and necrosis ensues.
  • Diagnosis is suggested by unilateral enlargement of a round or oval-shaped ovary containing multiple enlarged peripheral cysts (caused by transudation of fluid into follicles). Free fluid is present in the majority of cases. Peripheral blood flow may be present but may be absent with infarction.
  • Ovarian hyperstimulation can present with abdominal pain and may show an enlarged multicystic ovary associated with ascites. However, the condition usually arises from ovarian hormone stimulation in the setting of infertility.
  • Polycystic ovary syndrome typically presents with menstrual disturbance, obesity and hyperandrogenism.

Endometrial polyp

  • Endometrial polyps are common benign tumours of the endometrial cavity.
  • They are most common after the age of 40 years and are rare before menarche.
  • Typical ultrasound appearance is of a hyperechoic endometrial mass which may or may not contain cystic spaces. A feeding vessel is often demonstrated from its base on power Doppler.
  • NB: Submucosal fibroids are generally of reduced echogenicity (hypoechoic).
  • On MRI, a mass which contains a central fibrous core that enhances post-contrast and also contains well-demarcated T2-hyperintense cysts suggests endometrial polyp.
  • An intact junctional zone and smooth tumour-myometrial interface also favour a polyp.