Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

When Should Isolated Fallopian Tube Torsion Be Considered As a Diagnosis?

October 2, 2009
Written by: , Filed in: Obstetric Ultrasound
  • Comments
.

The objective of a recent study was to ascertain common findings in isolated fallopian tube torsion (IFTT) on sonogram and CT.

The study results indicate that isolated fallopian tube torsion should be considered for perimenarcheal girls who present with acute pelvic pain and demonstrate a cystic mass in a midline position.

Participants
Over an 11-year retrospective period, hospital charts and imaging studies of girls who had a discharge diagnosis of adnexal torsion were included. Of these, patients who also had a diagnosis of ovarian torsion were excluded.

Methodology
Preoperative imaging results as well as clinical and pathological findings were reviewed.

Women’s and Breast Imaging

New York University Post-Graduate Medical School and the Department of Radiology This course is designed for the practicing radiologist with particular interest in women’s imaging and breast imaging. During the women’s imaging segment, the participating faculty will discuss each of the imaging modalities applied to obstetrical and gynecological imaging including ultrasound, MRI and CT. Practical and multimodality approaches to common imaging problems in the female pelvis will be emphasized, including imaging of the patient with pelvic pain, evaluation of adnexal masses and assessment of benign and malignant disorders of the uterus. Topics in obstetrical imaging will include requirements for the sonographic fetal anatomic survey, sonographic evaluation of obstetrical emergencies, normal and abnormal first trimester pregnancy and imaging pitfalls. The role of MR and CT in the evaluation of the pregnant patient will also be discussed. Click here to read more or order: Women’s and Breast Imaging

Results
8 patients were identified to have IFTT on pathologic evaluation and were included in the study. Ages ranged from 12 to 15 years. Only 2 girls were premenarcheal.

All girls presented with pelvic pain. All patients were imaged with ultrasound. Ultrasound studies demonstrated a cystic pelvic mass in 7 of 8 girls, with a torsed dilated fallopian tube specifically identified in the other girl. Masses ranged from 2 to 11 cm.

Three of 8 girls underwent CT scanning. CT scans also demonstrated a midline cystic mass in 2 girls and a dilated tubular structure in the third.

Both ovaries were identified in all 3 girls who underwent CT scanning, and in all 3, the uterus was deviated toward the affected side. In 7 girls, pathologic evaluation demonstrated ipsilateral adnexal cysts associated with the torsed tube; 5 were described as paratubal and 2 were paraovarian. Average cyst diameter was 9 cm. One girl had torsion of an otherwise normal tube.

Conclusions
IFTT is an extremely rare event, occurring in 1 of 1,500,000 women. However, it should be considered in perimenarcheal girls who present with pelvic pain and when imaging demonstrates a midline cystic mass with a normal ipsilateral ovary. Ultrasound is favored in the evaluation of acute pelvic pain in girls.

Reviewer’s Comments
Preoperative diagnosis of IFTT is difficult because of nonspecific presenting symptoms. Although this article seeks to define imaging characteristics that are more specific for this condition, the small sample size and the rarity of the condition preclude definitive conclusions. Although IFTT is within the differential for any pelvic pain, the radiologist addressing acute pelvic pain is better served considering the more common events such as ovarian torsion, cyst rupture, ectopic pregnancy, pelvic inflammatory disease, urolithiasis, or appendicitis.

Author: : Basil Hubbi, MD

Reference: :
Harmon JC, Binkovitz LA, Binkovitz LE: Isolated Fallopian Tube Torsion: Sonographic and CT Features.
Pediatr Radiol; 2008; 38 (February): 175-179

Women’s and Breast Imaging

New York University Post-Graduate Medical School and the Department of Radiology This course is designed for the practicing radiologist with particular interest in women’s imaging and breast imaging. During the women’s imaging segment, the participating faculty will discuss each of the imaging modalities applied to obstetrical and gynecological imaging including ultrasound, MRI and CT. Practical and multimodality approaches to common imaging problems in the female pelvis will be emphasized, including imaging of the patient with pelvic pain, evaluation of adnexal masses and assessment of benign and malignant disorders of the uterus. Topics in obstetrical imaging will include requirements for the sonographic fetal anatomic survey, sonographic evaluation of obstetrical emergencies, normal and abnormal first trimester pregnancy and imaging pitfalls. The role of MR and CT in the evaluation of the pregnant patient will also be discussed. Click here to read more or order: Women’s and Breast Imaging
.
  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.