Ovarian torsion in girls: ultrasound and Doppler findings, the pitfall of preserved blood flow

In the available fragments, ovarian torsion in girls is directly addressed through references to specialized reviews (Chang HC et al. "Pearls and pitfalls in diagnosis of ovarian torsion", Radiographics 2008; Bandarkar AN, Blask AR "Testicular torsion with preserved flow", Pediatr Radiol 2018); however, detailed numerical criteria and a complete list of findings are not provided in the supplied material. Below are presented only those statements that are supported by the fragments.

The concept of preserved blood flow as a diagnostic pitfall

The phenomenon of "torsion with preserved flow" has been described for testicular torsion (Bandarkar & Blask, Pediatr Radiol 2018) and by analogy is relevant for ovarian torsion: the presence of arterial and/or venous signal on color Doppler does not exclude torsion. Therefore, reliance solely on Doppler blood flow leads to false-negative conclusions. [clarification needed—specific Doppler patterns in ovarian torsion are not detailed in the provided fragments]

Diagnostic pitfalls

The topic of errors and "pearls" in the diagnosis of ovarian torsion is systematized in the source by Chang HC et al. (Radiographics 2008; 28(5):1355–1368). Specific morphological criteria (ovarian size, position, stromal edema, peripheral displacement of follicles, etc.) are not presented in the cited fragments. [clarification needed]

Methodological principles applicable to the examination

Pelvic ultrasound examination is performed in accordance with the ACR-ACOG-AIUM-SPR-SRU Practice Parameter for the Performance of Ultrasound of the Female Pelvis (2024). Assessment of free fluid in the pouch of Douglas is a standard component of pelvic examination (according to the Delphi study by Andersen et al., 2026—high level of expert consensus, 92.86%).

Practical conclusion

In cases of clinical suspicion of ovarian torsion in a girl, preserved blood flow on color Doppler should not serve as grounds for excluding the diagnosis. The decision should be made based on the totality of findings and clinical presentation; in cases of doubt, further escalation is indicated. [clarification needed—threshold and morphological criteria require reference to the original sources Chang 2008 and Bandarkar 2018]