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Pelvis » Female Pelvis (Gynecology)
Isolated spontaneous tubal torsion
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Presentation A 19 year old female presented with acute onset left adnexal pain. A pelvic ultrasound was performed.
Caption: Sagittal scan of the uterus
Description: The uterus with the normal endometrial stripe is noted.
Caption: Sagittal image of the left adnexa
Description: There is a hypoechoic structure seen in the left adnexa that appears cystic, contains low-level internal echoes,some debri and thin septae. The mass shows good posterior enhancement.
Caption: Transverse image of the left adnexa
Description: The cystic structure is noted again and shows very thin, barely perceptible walls. The patient had probe tenderness while scanning this structure.
Caption: Transverse scan of the left adnexa
Description: The cystic structure is noted again displaying the homogeneous low-level internal echoes.
Differential Diagnosis Hemorrhagic left ovarian cyst, isolated left tubal torsion

Final Diagnosis Isolated left tubal torsion
Discussion This case has been illustrated here to demonstrate the rare diagnosis of an isolated case of tubal torsion occurring de novo. Tubal torsion usually occurs in combination with ipsilateral ovarian torsion. According to Yalcin, et al, predisposing factors for tubal torsion include hydrosalpinx, prior tubal operation, pelvic congestion, trauma and ovarian and para-ovarian masses. Patients usually present with acute abdomen and the diagnosis is only confirmed on surgery.
Follow Up Surgery confirmed a spontaneously torsed distended left fallopian tube.
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