1. What signs or symptoms make the diagnosis of ovarian torsion more likely? What factors in the patient’s history should make you more suspicious for torsion? How useful is the bi-manual exam?
2. Time is ovary? If a patient presents to the ED 24 hours after the onset of pain, is the ovary salvageable?
3. What imaging modalities do you use to diagnose ovarian torsion? How good are these studies?
4. Do you consider torsion if imaging reveals a normal ovary? In which patients do you worry about torsion of an otherwise normal ovary? When do you insist on this diagnosis with your OB-Gyn colleagues?
EM Lyceum 
1. Sharp sudden onset pain, LQ region.
2. Possibly if it’s had an intermittent nature (partial torsion with periods of flow) I’d still order a doppler study to look for evidence of blood flow
3. Ultrasound, very high sensitivity and specificity
4. US with normal ovary could still be ovary at risk for torsion if the patient is pain free now – coudl have been an intermittent torsion that detorsed spontaneously (but could also get into trouble in the future). Most worrisome if there is a history of waxing and waning pain
Muchas gracias. ?Como puedo iniciar sesion?