Pelvic ultrasound with color and power Doppler was performed to evaluate acute left lower quadrant pain in a young female. Gray-scale (B-mode) imaging demonstrates a normal right ovary with preserved parenchymal echotexture and a small left ovarian hemorrhagic cyst, with several tiny peripheral follicles. A pivotal radiologic finding is a twisted vascular pedicle just cranial to the left ovary, compatible with ovarian torsion. Color Doppler evaluation shows absence of detectable arterial and venous flow within the left ovary, while the right ovary maintains normal perfusion. The left ovary is tender to transducer pressure, and pedicle twist explains the acute presentation with vomiting. The absence of Doppler flow is highly specific for torsion, although a normal flow pattern does not completely exclude it. The exam emphasizes searching for an underlying ovarian mass or hemorrhagic cyst as a possible precipitating lesion. The radiologic diagnosis supports urgent surgical exploration to preserve ovarian viability. Clinical correlation includes abrupt onset abdominal pain in a reproductive-age patient, nausea, vomiting, and localized adnexal tenderness. Differential considerations include early torsion with intermittent flow, hemorrhagic corpus luteum cyst, adnexal mass, or adnexitis. This case underscores the diagnostic value of color Doppler in acute pelvic pain and the need for prompt gynecologic consultation.

This diagnostic image consists of two side-by-side transabdominal pelvic ultrasound panels with color Doppler flow assessment, comparing the bilateral adnexa. The left panel, labeled 'Trans L’t Adnexa,' displays a large, hypoechoic, and relatively homogeneous mass. The superimposed color Doppler reveals a significant absence of internal vascularity, with only a negligible blue signal visible, and the corresponding pulsed-wave Doppler at the bottom shows minimal spectral activity, a finding highly suggestive of ovarian torsion. In contrast, the right panel, labeled 'Trans Rt Ovary,' shows a more heterogeneous ovarian structure with robust color Doppler signals (red and blue), indicating preserved arterial and venous blood flow. This side-by-side comparison serves as a classic educational example of how Doppler sonography is used to evaluate suspected adnexal torsion by demonstrating the loss of blood flow to the affected organ compared to the normal contralateral ovary. The image is relevant for gynecology and emergency medicine training regarding the diagnosis of acute pelvic pain.

Gross pathology photograph of a salpingo-oophorectomy specimen from an adult female with acute pelvic pain. The excised adnexa measures approximately 10 x 8 x 6 cm and comprises an ovary adherent to the fallopian tube. The external surface is bosselated and variably dark bluish black in color. The parenchyma contains multiple cysts filled with altered blood and clots, separated by conspicuous fibrous septae, consistent with hemorrhagic degeneration. On gross inspection, ischemic necrosis predominates in most areas, with focal viable zones displaying serous cystadenoma-like features. The specimen is multiloculated with a thick capsule and torsion-related vascular compromise. Ovarian torsion, or adnexal torsion, involves rotation of the ovary and part of the tube around its vascular pedicle and is a surgical emergency requiring prompt intervention to prevent necrosis. Hemorrhagic infarction reflects obstruction of arterial inflow with venous outflow stasis. The narrative notes torsion's bimodal age distribution, affecting reproductive-age and postmenopausal women, with risk factors including benign and malignant neoplasms and corpus luteum cysts. Clinically, these findings align with severe abdominal pain, acute pelvic condition, and ultrasound-detected complex adnexal mass. This specimen illustrates torsion with hemorrhagic cysts and a benign serous neoplasm component, valuable for teaching, differential diagnosis, and surgical pathology education.

Gross pathology photograph of an ovarian mass from a 16-year-old female, consistent with a mature cystic teratoma (dermoid cyst). The specimen is opened to reveal classic dermoid contents: hair, sebaceous material, and adipose tissue arranged within a fluctuant multilocular cyst. The cyst wall is lined by stratified squamous epithelium with keratinous debris; surrounding ovarian stroma shows fibrous tissue without invasion. Internal components demonstrate ectodermal derivatives including hair shafts and sebaceous glands; adipose tissue and occasionally calcified fragments may be present. The mass is largely benign in behavior, typically unilateral, and often presents with abdominal pain or mass effect in adolescence; torsion is a known complication. Histologically, mature tissues from ectodermal, mesodermal, and endodermal origins can be seen, but in this specimen no immature neural elements or malignant transformation are evident. The gross appearance and cut-open configuration strongly support diagnosis of a mature cystic teratoma, which is the most common ovarian neoplasm in young girls. Clinically, this lesion requires surgical excision with preservation of ovarian tissue when possible; prognosis is excellent after complete resection. Radiologic imaging (ultrasound, CT, MRI) typically demonstrates a fat-containing cyst with echogenic sebaceous material, aiding differential diagnosis prior to pathology.