Ultrasound of a torsed ovary: characteristic gray-scale appearance despite normal arterial and venous flow on Doppler

Background: We present the case of an 8-year-old girl with acute onset of intermittent lower abdominal pain. The gray-scale US examination showed an enlarged right ovary with peripheral cysts, reflecting ovarian congestion and strongly suggesting the diagnosis of torsion. Normal arterial and venous flow, however, was found on Doppler US. Objective: To demonstrate the importance of gray-scale US findings despite the presence of blood flow found on Doppler US in salvaging a viable, torsed ovary. Methods: Despite the Doppler findings, a presumptive diagnosis of ovarian torsion was made. Results: Surgery confirmed the presence of a torsed ovary, which was viable and appeared normal after detorsion. Conclusion: This case illustrates that the gray-scale US appearance of the ovary can be more reliable than Doppler US for the diagnosis of ovarian torsion.