Adnexal Torsion Features in Ultrasonography

Adnexal Torsion Features

• Midline position of the ovary can be observed posterior to or above the bladder.
• Twisted vascular pedicle appearance may be round or beaked, showing multiple concentric hypo- and hyperechoic stripes.
• Ipsilateral deviation of the uterus indicates the side affected by torsion.
• Acoustic enhancement signifies vascular engorgement and stromal edema.

Doppler Imaging Findings

• Little or no intraovarian venous flow is an early sign of torsion.
• Absent arterial flow and reversed diastolic flow may also indicate torsion.
• Presence of arterial flow can occur due to dual blood supply from uterine and ovarian arteries.
• Diagnosis of torsion can be suggested with typical gray-scale appearance regardless of color flow pattern.

Isolated Tubal Torsion

• Rare cause of acute lower quadrant pain, more common in girls at puberty.
• Right fallopian tube is more frequently involved than left.
• Sonography displays a dilated fallopian tube, possibly with low-level internal echoes and thickened walls.

Uterine Measurements in Prepubertal Girls

• Maximum AP diameter and volume of the uterus vary with age, with specific measurements outlined for ages 2 to 13.
• Uterine body-to-cervix ratio approaches 1.5:1 by puberty.

Pubertal Uterus Development

• Uterine fundus elongates and thickens during puberty, yielding a pear-shaped configuration.
• Uterine dimensions at onset of menarche are approximately 5 to 8 cm in length and 1.6 to 3 cm in maximum AP diameter.

Endometrial Physiology

• The endometrium comprises a central functional layer that thickens and sheds, and a peripheral basal layer that remains intact.
• Endometrial thickness varies with menstrual cycle phases, from thin (up to 4 mm) during menstruation to 15-16 mm during the secretory phase.

Bicornuate Uterus

• Characterized by a concave indentation of the uterine fundus, dividing the organ into two horns.
• The bicornuate uterus does not typically require surgical intervention, and affected patients are usually asymptomatic.

Septate Uterus

• Most common Müllerian anomaly resulting from incomplete resorption of the septum between Müllerian ducts.
• Patients often asymptomatic, though spontaneous abortions are more common; treatment involves septum resection.

Precocious Puberty

• Central precocious puberty involves premature development due to pituitary hormones, leading to enlarged ovaries and adult uterine morphology.
• Peripheral precocious puberty arises from gonadotropin-independent estrogen production, maintaining low serum gonadotropin levels.
• Causes include functioning ovarian cysts, adrenal tumors, and estrogen ingestion; ultrasound aids in assessing size and morphology of reproductive organs.