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This is an MRI of a patient who presented with

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exquisite right lower quadrant pelvic pain.

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Now, this patient is not pregnant, but the

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features of this case are so classic that

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I feel it's important to show it to you.

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This patient had a pelvic ultrasound,

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which demonstrated an enlarged right ovary.

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However, when they did that exam, they felt

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they were able to see flow to the right ovary.

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In light of the patient's

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persistent pain, an MRI was ordered.

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This is a T2 fat-saturated image of the pelvis.

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As we scroll down, we can nicely see

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the distinct layers of the uterus,

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the uterine serosa, myometrium,

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junctional zone, and endometrium.

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We can very clearly identify the

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left ovary, which has multiple T2

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hyperintense follicles within it.

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As we scroll inferiorly into the pelvis,

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we see a large, relatively T2 hyperintense

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mass, with multiple peripherally located

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well-circumscribed T2 hyperintensities.

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There's a small amount of surrounding

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free fluid, and also surrounding what are

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follicles in this enlarged right ovary,

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we can see a rim of T2 hypointensity.

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This is perifollicular hemorrhage

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in this patient with peripheral

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displacement of the ovarian follicles.

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As we scroll superiorly back toward the

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uterus, we can see a classic whirlpool

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sign where the vascular pedicle extending

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from the right lateral aspect of the uterus

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toward the right ovary is swirling on

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itself in this patient with ovarian torsion.

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Because this patient is not pregnant, we

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were also able to administer intravenous

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gadolinium-based contrast for this MRI.

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And in this post-contrast image of the

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pelvis, we can see that there's relative

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global hypoenhancement of the right ovary,

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which was infarcted at the time of surgery.

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So this is a case of ovarian torsion with

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unfortunately ovarian infarction on MRI.