The ovary has a dual blood supply, from the ovarian artery and the uterine artery, and torsion is often intermittent or incomplete. So arterial flow is frequently still demonstrable in a torted ovary, and a report that says 'arterial flow present, torsion unlikely' can send a patient home to lose the ovary.
Weight the greyscale findings instead. An enlarged, oedematous ovary, peripherally displaced follicles, an abnormally positioned ovary — sitting midline or above the uterine fundus — a twisted vascular pedicle or whirlpool sign, and free fluid together carry far more than the presence of arterial signal. Absent venous flow is an earlier and more useful sign than absent arterial flow, because the thinner-walled veins occlude first.
And say so in the report. Where the clinical picture is sudden severe unilateral pelvic pain with vomiting, write that normal Doppler does not exclude torsion and that the decision is surgical. The referring team will otherwise read flow as reassurance.
- Never report present arterial flow as excluding torsion.
- Look for ovarian enlargement, peripheral follicles and an abnormal ovarian position first.
- Absent or reduced venous flow precedes loss of arterial flow — check it deliberately.
- Hunt for the whirlpool sign of the twisted pedicle in the adnexa.
- State in the report that a normal Doppler does not exclude torsion when the history fits.
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