A meta-analysis reported a similar pooled sensitivity and specificity in diagnosing adnexal torsion using Doppler US (7 studies, 845 patients, sensitivity 80% and specificity 88%) compared with the grayscale US only (12 studies, 1,187 patients, sensitivity 79% and specificity 76%) [22]. Ovarian torsion may lead to adnexal necrosis and infertility, so early detection is essential. A prospective study on 159 patients showed that all patients with adnexal torsion had absent flow or abnormal flow pattern in the ovarian Acute Pelvic Pain in the Reproductive Age Group vein. In 13 patients whose only abnormality was absent or abnormal ovarian venous flow with normal grayscale US appearance and normal arterial blood flow, 8 of those patients (62%) had adnexal torsion or subtorsion [29]. In cases of adnexal torsion, a whirlpool sign can be located either lateral or medial to the affected ovary. A larger volume of the ovarian or paraovarian mass was associated with a greater probability of a lateral whirlpool sign in a small retrospective study of 30 patients [30]. A retrospective study of 22 patients evaluated for adnexal torsion with whirlpool sign on US, 90.0% of whom had adnexal torsion confirmed on laparoscopy [31]. Power Doppler TVUS was 100% sensitive and 80% specific in PID diagnosis (overall accuracy 93% in a study of 30 patients with PID and 20 patients with hydrosalpinx as a control group) [32]. Specific US signs of PID, including wall thickness >5 mm, cogwheel sign, incomplete septa, and the presence of cul-de-sac fluid, discriminated patients with acute PID from the control group of patients with hydrosalpinx. Doppler US findings of hyperemia and lower pulsatility index allowed further discrimination between PID and hydrosalpinx with a high level of significance (P < . 01) [32]. US Pelvis Transvaginal A combined transabdominal and transvaginal approach is typically used for pelvic US imaging, and both should be performed when possible.
Acute Pelvic Pain in the Reproductive Age Group. A meta-analysis reported a similar pooled sensitivity and specificity in diagnosing adnexal torsion using Doppler US (7 studies, 845 patients, sensitivity 80% and specificity 88%) compared with the grayscale US only (12 studies, 1,187 patients, sensitivity 79% and specificity 76%) [22]. Ovarian torsion may lead to adnexal necrosis and infertility, so early detection is essential. A prospective study on 159 patients showed that all patients with adnexal torsion had absent flow or abnormal flow pattern in the ovarian Acute Pelvic Pain in the Reproductive Age Group vein. In 13 patients whose only abnormality was absent or abnormal ovarian venous flow with normal grayscale US appearance and normal arterial blood flow, 8 of those patients (62%) had adnexal torsion or subtorsion [29]. In cases of adnexal torsion, a whirlpool sign can be located either lateral or medial to the affected ovary. A larger volume of the ovarian or paraovarian mass was associated with a greater probability of a lateral whirlpool sign in a small retrospective study of 30 patients [30]. A retrospective study of 22 patients evaluated for adnexal torsion with whirlpool sign on US, 90.0% of whom had adnexal torsion confirmed on laparoscopy [31]. Power Doppler TVUS was 100% sensitive and 80% specific in PID diagnosis (overall accuracy 93% in a study of 30 patients with PID and 20 patients with hydrosalpinx as a control group) [32]. Specific US signs of PID, including wall thickness >5 mm, cogwheel sign, incomplete septa, and the presence of cul-de-sac fluid, discriminated patients with acute PID from the control group of patients with hydrosalpinx. Doppler US findings of hyperemia and lower pulsatility index allowed further discrimination between PID and hydrosalpinx with a high level of significance (P < . 01) [32]. US Pelvis Transvaginal A combined transabdominal and transvaginal approach is typically used for pelvic US imaging, and both should be performed when possible.