Yuko Kobashi, Yoshimasa Imanishi, Ken Kamijo, Shinjiro Sakaino, Misako Yoshimatsu, Yasuo Nakajima, Shiho Hamano1）, Yuriko Sato1）, Munechika Wakisaka1）,Mieko Odanaka2）
Department of Radiology, Pediatric surgery1）, and Pathology2）, St.Marianna University School of Medicine
In children, torsion of a paraovarian cyst is rare and very difficult to diagnose before surgery, because almost all patients with a paraovarian cyst have no symptoms until there is torsion, hemorrhage or rupture. In this paper, we report the case of a 12-year-old girl who had torsion of one of several paraovarian cysts.
She had had right lower abdominal pain for 3 days. Abdominal ultrasonography and CT showed multiple cystic lesions in her pelvic cavity at the left dorsal aspect of the uterus, which had thickened walls and different contents. We diagnosed torsion of an ovarian tumor with intracystic hemorrhage. However at operation, several cysts were seen along the left fallopian tube, the largest one of which had been twisted 720 degrees around the fimbriae of the tube. The twisted cyst showed hemorrhage and necrosis and the fimbriae congestion. Paraovarian cyst is pathologically classified into mesothelial, mesonephric, and paramesonephric types. The cysts in our case belonged to the mesothelial type. As mesothelial type cysts are sensitive to gonadal hormones, they show a tendency to become larger and have more complications in children than the others. Thus, a radiologist should remember paraovarian cysts in the differential diagnosis of ovarian cysts in a girl at puberty.
Keywords：Torsion, Paraovarian cyst, Wolffian duct, CT, Ultrasound