The mass effect of ovarian tumors is also a common cause of torsion. Torsion of the ovary usually occurs with torsion of the fallopian tube as well on their shared vascular pedicle around the broad ligament, although in rare cases the ovary rotates around the mesovarium or the fallopian tube rotates around the mesosalpinx. In 80%, torsion happens unilaterally, with slight predominance on the right. In ovarian torsion, the ovary rotates around both the infundibulopelvic ligament (ie, suspensory ligament) and the utero-ovarian ligament (i.e. ovarian ligament), disrupting blood flow to the ovary. Diagnosis
Ovarian torsion is difficult to diagnose accurately, and operation is often performed before certain diagnosis is made. A study at an  obstetrics and gynaecology department found that preoperative diagnosis of ovarian torsion was confirmed in only 46% of people. Ultrasound
Gynecologic ultrasonography is the imaging modality of choice. Use of doppler ultrasound  in the diagnosis has been suggested. However, doppler flow is not always absent in torsion – the definitive diagnosis is often made in the operating room.Lack of ovarian blood flow on doppler sonography seems to be a good predictor of ovarian torsion. Women with pathologically low flow are more likely to have torsion. The sensitivity and specificity of abnormal ovarian flow are 44% and 92%, respectively, with a positive and negative predictive value of 78% and 71%, respectively. Specific flow features on Doppler sonography include:
Little or no intra-ovarian venous flow. This is commonly seen in ovarian torsion. Absent arterial flow.
Purpura () is a condition of  red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, or other causes. They measure 3–10 mm, whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.Purpura is common with typhus and can be present with meningitis caused by meningococci or septicaemia. In particular, meningococcus (Neisseria meningitidis), a Gram-negative diplococcus organism, releases endotoxin when it lyses. Endotoxin activates the Hageman factor (clotting factor XII), which causes disseminated intravascular coagulation (DIC). The DIC is what appears as a rash on the affected individual. Classification
Purpura are a common and nonspecific medical sign; however, the underlying mechanism commonly involves one of:

Platelet disorders (thrombocytopenic purpura)
Primary thrombocytopenic purpura
Secondary thrombocytopenic purpura
Post-transfusion purpura
Vascular disorders (nonthrombocytopenic purpura)
Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged
Hypertensive states
Deficient vascular support
Vasculitis, as in the case of Henoch–Schönlein purpura
Coagulation disorders
Disseminated intravascular coagulation (DIC)
Scurvy (vitamin C deficiency) – defect in collagen synthesis due to lack of hydroxylation of procollagen results in weakened capillary walls and cells
Meningococcemia
Clumping fibrillary protein deposits caused by Amyloidosis
Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities, sometimes needing reconstructive surgery. Levamisole is purportedly a common cutting agent. Decomposition of blood vessels including purpura is a symptom of acute radiation poisoning in excess of 2 Grays of radiation exposure.