A 21 year old woman admitted to our emergency department with
progressive low abdominal pain started in a few hours. She had no surgical,
clinical or family history before. Physical examination revealed tenderness,
defence, rebound in bilateral lower quadrants and a palpable
mass located in right adnexial region. Her complete blood account and
biochemical profile were in normal limits. Contrast enhanced computer
tomography of abdomen showed bilateral ovarian masses containing
fat attenuation which was characteristic for dermoid cysts (Figure 1a-b)
and free pelvic fluid. Additionally in right dermoid, there was hyperattenuating
debris inside and a twisted pedicle (Figure 1b). This appearance
was suggestive for adenexial torsion. Under general anaesthesia surgery
was performed, bilateral torsioned dermoids and gangrene were found.
Postoperative period was uneventful and patient discharged a few days
later. Intratumoral fat attenuation is typical CT finding of dermoids that
found 93% of cases. In some cases a floating mass of hair that called Rochitansky
nodule, teeth or calcification could be detected inside of the
mass. Large cystic teratomas that over 11 cm could lead to torsion of adnex.
No vascular supply on colour Doppler and detection of the twisted
or distended pedicle on CT imaging is suggestive for torsion (1, 2).