Abstract
In women of reproductive age with acute abdominal pain, gynecologic or pregnancy-related disorders should be considered. We present a patient's case in which it was difficult to distinguish between ovarian tumor torsion and subserosal uterine leiomyoma torsion. The emergency contrast-enhanced CT findings revealed typical findings of subserosal uterine leiomyoma torsion. The patient was a 29-year-old woman with worsening acute lower abdominal pain who was transferred to our hospital after being suspected of having ovarian tumor torsion or subserosal uterine leiomyoma torsion. Since she had increasing pain and an inflammatory response, laparoscopic surgery was performed the following day. The subserosal uterine leiomyoma torsion was identified on the ventral side of the uterine corpus.
Subserosal uterine leiomyoma torsion is a rare disease that can cause hemorrhagic necrosis, peritonitis, and sepsis, which can be life-threatening. Since ultrasound and MRI are not always useful for diagnosing this disease, it is important to determine whether contrast-enhanced CT scans can reveal findings suggesting subserosal uterine leiomyoma torsion. The following findings facilitate the differentiation of subserosal uterine leiomyoma torsion from other diseases on contrast-enhanced CT: (i) poor contrast enhancement, (ii) thin rim enhancement, and (iii) dark fan sign. In particular, the dark fan sign has high specificity. In the present patient's case, the findings on contrast-enhanced CT were consistent with all of these features.
Normal bilateral ovaries were identified in our patient, and there were no signs of ovarian tumor torsion on the contrast-enhanced CT scan. When normal bilateral ovaries are identified in this manner, ovarian tumor torsion can be ruled out. However, this is often difficult in practice. As this patient's case shows, it is important to evaluate contrast-enhanced CT findings in women of reproductive age with acute abdominal pain when considering subserosal uterine leiomyoma torsion in the differential diagnosis.
