Diagnostic failures in ovarian torsion during childhood: The effect of ovarian cyst size on the diagnostic accuracy of Doppler ultrasonography

• Published in: Journal of clinical ultrasound Vol. 50; no. 5; pp. 660 - 665
• Main Authors: Ulusoy, Oktay, Karakuş, Osman Zeki, Ateş, Oğuz, Hakgüder, Gülce, Olguner, Mustafa, Akgür, Feza Miraç
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.06.2022; Wiley Subscription Services, Inc
• Subjects: Accuracy; Children; Complications; Cysts; Diagnosis; Diagnostic systems; Doppler effect; Doppler ultrasonography; Laparoscopy; ovarian cyst; ovarian torsion; Ovaries; Patients; Pediatrics; Postoperative; Signs and symptoms; Ultrasonic imaging; United States > US; laparoscopy; Doppler ultrasonography; ovarian cyst; ovarian torsion
• ISSN: 0091-2751; 1097-0096
• DOI: 10.1002/jcu.23167

Purpose To determine the diagnostic accuracy of Doppler ultrasonography (US) in pediatric ovarian torsion (OT) and the effect of ovarian cyst size on the effectiveness of Doppler US in pediatric OT. Methods We retrospectively reviewed of the data of 84 patients (4–17 years) operated with the preliminary diagnosis of OT from January 2007 to December 2019. Patients' demographic characteristics, clinical signs and symptoms, laboratory and radiologic findings, operative management, histopathological results, and postoperative complications were recorded. Results OT was surgically confirmed in 53 (63%) patients. In 30 patients without ovarian cyst, Doppler US suggested OT in 16 out of 22 patients with surgically confirmed OT. In 12 patients with ovarian cysts <5 cm, Doppler US suggested OT in 7 out of 8 patients with surgically confirmed OT. In 42 patients with ovarian cysts ≥5 cm, Doppler US suggested OT in 13 out of 23 patients with surgically confirmed OT. Accuracy of Doppler US in these groups were found to be 73%, 83%, and 47%, respectively. Conclusion Gray scale and Doppler US have better performance in patients without ovarian cysts and with cysts smaller than 5 cm and help improve the diagnosis of OT. In patients with ovarian cyst ≥5 cm, accuracy of Doppler US is low. Thus, in the presence of ovarian cyst ≥5 cm and the clinical findings compatible with OT, laparoscopy must be strongly considered. Flow‐chart of the Doppler US results.