Gonzales, Noelani

Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion. A 2024 review described fewer than 150 cases over several decades. The clinical presentation of IFTT is highly variable and nonspecific, which may result in delayed diagnosis. Most patients present with acute unilateral abdominal pain with nausea and/or vomiting, while other patients may present with more gradual symptoms. Risk factors for IFTT include adnexal lesions, hydrosalpinx, previous pelvic surgery, and pelvic inflammatory disease. Ultrasound is particularly useful in identifying the imaging signs of IFTT, which include normal ovarian size and flow, a distended cylindrical structure that tapers to a “beak” adjacent to the ovary, thickened endosalpingeal folds resulting in a “cogwheel” appearance, and, lastly, a twisted vascular pedicle. We present an imaging-focused case in which the diagnosis of IFTT using ultrasound, following equivocal CT, resulted in prompt and confirmatory surgical management. Our goal is to raise awareness of IFTT as a possibility in females with abdominal pain and to discuss ultrasound characteristics that may increase clinical suspicion and diagnostic confidence. Prompt recognition and surgical management may prevent tubal necrosis and loss of fertility.

Endometriosis is a chronic inflammatory condition affecting 10% to 15% of reproductive-aged women. The urinary tract is the second most common extragenital site of endometriosis after the gastrointestinal tract, with a prevalence of 15% to 50% of women with deep endometriosis (DE). The urinary bladder is the most common site of urinary tract involvement (85%), followed by the ureter (10%), kidney (4%), and urethra (2%). Urinary bladder (anterior compartment) and ureter (mediolateral compartment) involvement are considered different disease entities. Patients with bladder involvement are more symptomatic with dysuria, urinary frequency, and recurrent urinary tract infections. Ureteral involvement is more commonly due to extrinsic compression, but may be intrinsic, involving the ureteral mucosa or muscularis. Hematuria is a rare presenting symptom of both bladder and ureteral involvement. Malignant transformation of urinary tract endometriosis is rare; however, DE involvement of the urinary tract may be mistaken for malignancy. Radiologists need a high index of suspicion for endometriosis in reproductive-aged women, and recognition of urinary tract involvement is important for timely treatment.