A Case Report of Uterine Torsion in a Postmenopausal Female with a Large Leiomyoma

Authors

Jennifer Qin Jennifer Qin, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, 10th Floor, Box 0132, San Francisco, CA 94158, USA.
Isabelle Wijangco Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco; San Francisco, USA
Marley Rashad Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco; San Francisco, USA
Mark Sugi Department of Radiology, University of California, San Francisco; San Francisco, USA
Stacy Young Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco; San Francisco, USA

DOI:

https://doi.org/10.3941/jrcr.v18i2.5035

Keywords:

Uterine torsion, leiomyoma, gynecologic emergency, whirlpool sign, X-shaped, pelvic MRI, pelvic CT

Abstract

This case report discusses a diagnosis of uterine torsion in an 84-year-old woman who presented with five days of right lower quadrant abdominal pain, nausea, vomiting, constipation, and poor intake. Computed tomography (CT) imaging demonstrated a whorled configuration at the junction of the cervix and lower uterine segment, with the left gonadal vein crossing midline, and two previously known right leiomyomas now appearing on the left. These findings were consistent with the diagnosis of uterine torsion. She then underwent an urgent exploratory laparotomy, and the uterus was found to be dextroverted 270 degrees, with dark mottled purple tissue and engorged vessels. A supracervical hysterectomy and bilateral salpingo-oopherectomy were performed. Final pathology demonstrated extensive necrosis. This case reviews the classic presentation and imaging findings for the rare diagnosis of uterine torsion and options for management of both nongravid and gravid patients.

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Published

2024-04-01

Issue

Vol. 18 No. 1 (2024)

Section

Obstetric & Gynecologic Radiology

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