Ovarian torsion: follow the pedicle

Question 1Which ultrasound sign is most specific for ovarian torsion?

1. aFree fluid in the pouch of Douglas
2. bA simple ovarian cyst
3. cIncreased flow in the ovary
4. dA twisted vascular pedicle, the whirlpool sign

Question 2A patient has sudden severe right pelvic pain and vomiting. The right ovary is enlarged with peripheral follicles, and arterial flow is present. What do you conclude?

1. aTorsion remains likely, so refer urgently to gynaecology
2. bThis is a haemorrhagic cyst, so discharge
3. cTorsion is excluded by the arterial flow
4. dThe scan is normal

Question 3Why find both ovaries before calling one abnormal?

1. aThe left ovary is always larger
2. bComparing sides shows which ovary is enlarged or oedematous
3. cDoppler only works when both are visible
4. dOne ovary is always absent