A recent systematic review in Pediatric Emergency Care attempted to identify the most reliable clinical, biological, and radiological signs of ovarian torsion in the pediatric population.

Ovarian torsion is a rare but serious cause of abdominal pain in pediatric patients with an incidence of 0.5-2 per 10,000 patients.

Delay in diagnosis correlates with decreased rate of ovarian salvage, but initial presenting symptoms and signs can be nonspecific, making the diagnosis difficult.

Although abdominal pain was cited as the most common complaint, there were few specific clinical signs and no reliable laboratory tests found in the review that could aid in the diagnosis of ovarian torsion.

Pelvic US was found to have only 79% sensitivity, and  the presence of vascular flow on Doppler studies did not rule out torsion.

Thus, ovarian torsion remains a difficult clinical diagnosis that cannot be reliably excluded via radiology.

Gasser CR, Gehri M, Joseph JM, Pauchard JY. Is it Ovarian Torsion? A Systematic Literature Review and Evaluation of Prediction Signs. Pediatr Emerg Care. 2016: 1-6.