Adnexal Torsion Imaging Diagnosis

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Acute pelvic pain · torsion signs
   Acute pelvic pain — specific torsion signs? (Adnexal/ovarian torsion, US preferred. Non-specific: enlarged ovary, abnormal position, hemorrhagic cyst/lead point, pelvic fluid. Specific signs in order of appearance: 1) twisted pedicle whirlpool/target sign (most specific, seen throughout); 2) follicular ring sign (thickened hyperechoic follicle walls 1–2 mm, early); 3) stromal edema + peripheral displacement of follicles; 4) absent Doppler flow (late). Note: normal flow does not exclude torsion (dual blood supply/intermittent).)
   • Specific signs such as whirlpool/follicular ring/stromal edema (especially with reduced flow) → Specific signs (+) · emergency detorsion
   • Only non-specific signs, but high clinical suspicion → High suspicion · laparoscopic exploration
   • A clear other cause, no torsion signs → Other cause · cause-directed management
2. [End] Other cause · cause-directed management
   A clear other cause found (simple cyst, PID, appendicitis, etc.) with no torsion signs: manage by that cause; if it still does not fit clinically, repeat/follow up with further imaging.
3. [End] High suspicion · laparoscopic exploration
   Only non-specific signs (enlarged ovary/fluid/lead point) but high clinical suspicion: normal flow does not exclude torsion; combined with clinical picture, early laparoscopic exploration (gold standard); delay causes ovarian necrosis, detorse and preserve the ovary promptly.
4. [End] Specific signs (+) · emergency detorsion
   Whirlpool/follicular ring/stromal edema seen (suspected torsion, especially with reduced/absent flow): gynecologic emergency, laparoscopic detorsion first (preserve the ovary where possible, do not remove just for a necrotic appearance); address the lead point (dermoid cyst, etc.) at the same time.

Source guidelines & references

• Adnexal torsion ultrasound diagnosis (GLOWM; specific signs: whirlpool sign/follicular ring sign/stromal edema)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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