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.

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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

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Interested in the latest news in the field of Obstetric Ultrasound?

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A new free Special Report is now available:

Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma

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Dear concerned radiology professional,

If you’re a practising radiologist, radiology resident or internist, you know how far Obstetric Ultrasound has advanced in recent years—even in the past few months, with newer and better imaging and more effective techniques emerging all the time.

So, what’s a busy radiologist to do?

First and foremost, stay on top of the latest research, and your CME requirements, particularly those Obstetric Ultrasound courses that address the latest technology and how to use it correctly and safely, as well as how to interpret your findings to aid in treatment decisions in the hope of the best patient outcome.

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Every professional caregiver has dedicated themselves to a lifetime of learning.

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This invaluable Special Report, Ultrasound of the Female Pelvis: Ectopic Pregnancy, Ovarian Masses and Endometrial Carcinoma, brings you invaluable advice on how to detect and diagnose these three main women’s health concerns.

In this special report, you will learn:

• How to Identify Ectopic Pregnancy:
• Who is at risk;
• The main reasons for ectopic pregnancies;
• The 4 key observations to detect normal pregnancy on ultrasound and rule out ectopic pregnancy;
• Evaluating ovarian masses on ultrasound;
• Why size matters when it comes to ovarian masses;
• How to approach ovarian masses in pre-menopausal women;
• How to approach ovarian masses in post-menopausal women;
• The main ovarian masses you will encounter on ultrasound;
• The main types of ovarian cysts;
• The characteristic appearance on a sonograph of the main types of ovarian cysts;
• How to approach ovarian masses if you locate them on ultrasound;
• Which types of ovarian cysts can be ruled benign upon ultrasound;
• Why practice is key when it comes to evaluating ovarian masses on ultrasound;
• Evaluating endometrial thickness with ultrasound;
• What is considered normal endometrial thickness in pre-menopausal women;
• Evaluating endometrial thickness in postmenopausal women;
• How your evaluation should differ if bleeding is present;
• Why it is important to identify atrophic endometrium with ultrasound;
• The appearance of endometrial carcinoma on ultrasound;
• Why focal thickenings of the endometrium are also important;
• The difference in appearance on ultrasound between endometrial polyps and submucous myomas.
• Further resources and suggested reading;
• And more…

Oakstone Medical Publishing is your reliable source for Obstetric Ultrasound CME.

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P.S. As any radiologist knows, when it comes to Obstetric Ultrasound, experience is key in detecting and treating disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

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Welcome to the Obstetric Ultrasound Section of Radiology Daily.

In the Obstetric Imaging section, we will be keeping you up to date on the latest information in the field of Obstetric ultrasound and other obstetrical screenings.
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