# MRI Revealing Ovarian Non-salvageable Torsion Masquerading as a Pelvic Mass in a Young Woman With Enterocystoplasty and Neurogenic Bladder

## TL;DR

A young woman with a neurogenic bladder and enterocystoplasty presented with a pelvic mass that was actually a non-salvageable ovarian torsion, highlighting the need for careful imaging and diagnosis in atypical cases.

## Contribution

This case report highlights the diagnostic challenges of ovarian torsion in patients with complex urological conditions and emphasizes the role of imaging in accurate diagnosis.

## Key findings

- MRI confirmed a non-viable, hemorrhagic ovary with a twisted vascular pedicle in a patient with atypical symptoms.
- Laparoscopic surgery confirmed torsion and required oophorectomy due to irreversible ischemic damage.
- The case underscores the importance of integrating ultrasound, CT, and MRI for timely diagnosis and management.

## Abstract

Adnexal torsion is a gynecological emergency requiring prompt diagnosis and intervention to prevent irreversible ovarian damage. This case report presents a 19-year-old female with a history of spina bifida, neurogenic bladder managed by enterocystoplasty, and chronic urinary retention, who presented with fluctuating pelvic and lumbar pain. Initial ultrasound showed bilateral hydronephrosis without obstruction, while subsequent imaging revealed a pelvic mass with features concerning for ovarian torsion. A non-contrast MRI confirmed a hemorrhagic, non-viable ovary with peripheral microfollicules and a twisted vascular pedicle, establishing the diagnosis of adnexal torsion with infarction. Laparoscopic surgery confirmed the torsion, necessitating oophorectomy due to irreversible ischemic damage. This case underscores the diagnostic challenges posed by atypical presentations, particularly in patients with pre-existing urological conditions. The differential diagnosis includes hemorrhagic ovarian cysts, endometriomas, ectopic pregnancy, and tubo-ovarian abscess, which can mimic torsion. Imaging plays a crucial role in differentiating these conditions and assessing ovarian viability. This report highlights the importance of a structured diagnostic approach, integrating ultrasound, CT, and MRI to optimize timely intervention and preserve ovarian function whenever possible. Radiologists should maintain a high index of suspicion in atypical cases to avoid delays in management and improve patient outcomes.