Ovarian torsion may be partial or intermittent, and the ovary has a dual blood supply, so arterial and venous flow can be present on Doppler despite torsion. The more reliable findings are an enlarged, oedematous ovary, often with peripherally displaced follicles, a twisted vascular pedicle (the whirlpool sign), and free fluid. A report should describe these features, not rest on flow alone.
- Do not exclude torsion on the basis of preserved Doppler flow.
- Look for an enlarged ovary and a twisted pedicle.
- Compare ovarian size and appearance with the other side.
- Recommend urgent gynaecological review when features suggest torsion.
Why it matters
A reassuring flow signal is the commonest way torsion is missed on ultrasound.
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