# Case report: preoperative radiological diagnosis of uterine torsion in the non-gravid uterus

## TL;DR

A rare case of uterine torsion in a non-pregnant woman was diagnosed pre-surgery using radiological imaging techniques.

## Contribution

This case highlights the importance of secondary radiological review in diagnosing rare conditions like uterine torsion.

## Key findings

- CT initially misdiagnosed the condition as a large adnexal mass.
- MRI confirmed uterine torsion using the 'X-sign' and lack of contrast uptake.
- Surgery confirmed the diagnosis with findings of haemorrhagic infarction.

## Abstract

This case report describes the rare occurrence of a pre-operative radiological diagnosis of uterine torsion in the non-gravid uterus. A 78-year-old female presented with a 5-day history of worsening non-specific gastrointestinal symptoms. Her admission CT study initially reported a large adnexal mass lesion causing obstruction of neighbouring small bowel loops. Management was initiated under the presumption of a complex uterine fibroid causing local small bowel obstruction. Only a secondary radiological review—conducted due to persistent abdominal pain—identified the characteristic “whirlpool” sign of the uterine cavity and prompted the differential of uterine torsion. Contrast-enhanced MRI study further confirmed this suggestion with a lack of uterine contrast uptake and the “X-sign.” The patient subsequently had an emergency laparotomy for a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intra-operative findings and further histological analysis demonstrated a distorted uterine cavity with haemorrhagic infarction, confirming a diagnosis of uterine torsion.