Emergent and nonemergent nonbowel torsion: Spectrum of imaging and clinical findings

Meghan G. Lubner, Marissa L. Simard, Christine Peterson, Sanjeev Bhalla, Perry J. Pickhardt, Christine O. Menias

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Although bowel torsion is more commonly described in the medical literature, torsion can affect various organs within the chest, abdomen, and pelvis, including the testes, ovaries, gallbladder, spleen, heart, and pulmonary lobes. A structural abnormality such as a mass (a "lead point") that promotes twisting around a vascular pedicle often predisposes an organ or other anatomic structure to torsion. Radiologists play a central role in detecting torsion, identifying the anatomy involved, and triaging patients for either emergent surgical intervention, which may be critical for organ salvage, or conservative management. Imaging fndings that are suggestive or indicative of emergent torsion include an ectopic location and enlargement or edema of part or all of an organ, decreased blood fow at color Doppler ultrasonography, and a twisted vascular pedicle. Blood fow to an organ is quickly compromised by the constriction of vessels within the twisted pedicle, and ischemia may result; a delay in diagnosis and surgical treatment can lead to complications such as infarction, hemor-rhagic necrosis, and abscess. By contrast, torsion of mobile fatty structures such as testicular appendages, epiploic appendages, omental fat, and pericar-dial fat pads, although it may produce pain mimicking that in an emergent condition, requires only conservative management. Imaging features of this nonemergent condition include a fatty mass, which is usually located alongside the colon when torsion involves the omentum or an epiploic appendage, with associated infammatory stranding and tenderness at palpation. The radiologist should be familiar with these manifestations of nonemergent torsion to prevent unnecessary surgical intervention.

Original languageEnglish (US)
Pages (from-to)155-173
Number of pages19
JournalRadiographics
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Blood Vessels
Doppler Color Ultrasonography
Omentum
Palpation
Gallbladder
Pelvis
Constriction
Abdomen
Abscess
Infarction
Adipose Tissue
Testis
Ovary
Edema
Anatomy
Colon
Necrosis
Thorax
Spleen
Ischemia

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Lubner, M. G., Simard, M. L., Peterson, C., Bhalla, S., Pickhardt, P. J., & Menias, C. O. (2013). Emergent and nonemergent nonbowel torsion: Spectrum of imaging and clinical findings. Radiographics, 33(1), 155-173. https://doi.org/10.1148/rg.331125016
Lubner, Meghan G. ; Simard, Marissa L. ; Peterson, Christine ; Bhalla, Sanjeev ; Pickhardt, Perry J. ; Menias, Christine O. / Emergent and nonemergent nonbowel torsion : Spectrum of imaging and clinical findings. In: Radiographics. 2013 ; Vol. 33, No. 1. pp. 155-173.
@article{849aa096cd444132bffad3bc2d3d14da,
title = "Emergent and nonemergent nonbowel torsion: Spectrum of imaging and clinical findings",
abstract = "Although bowel torsion is more commonly described in the medical literature, torsion can affect various organs within the chest, abdomen, and pelvis, including the testes, ovaries, gallbladder, spleen, heart, and pulmonary lobes. A structural abnormality such as a mass (a {"}lead point{"}) that promotes twisting around a vascular pedicle often predisposes an organ or other anatomic structure to torsion. Radiologists play a central role in detecting torsion, identifying the anatomy involved, and triaging patients for either emergent surgical intervention, which may be critical for organ salvage, or conservative management. Imaging fndings that are suggestive or indicative of emergent torsion include an ectopic location and enlargement or edema of part or all of an organ, decreased blood fow at color Doppler ultrasonography, and a twisted vascular pedicle. Blood fow to an organ is quickly compromised by the constriction of vessels within the twisted pedicle, and ischemia may result; a delay in diagnosis and surgical treatment can lead to complications such as infarction, hemor-rhagic necrosis, and abscess. By contrast, torsion of mobile fatty structures such as testicular appendages, epiploic appendages, omental fat, and pericar-dial fat pads, although it may produce pain mimicking that in an emergent condition, requires only conservative management. Imaging features of this nonemergent condition include a fatty mass, which is usually located alongside the colon when torsion involves the omentum or an epiploic appendage, with associated infammatory stranding and tenderness at palpation. The radiologist should be familiar with these manifestations of nonemergent torsion to prevent unnecessary surgical intervention.",
author = "Lubner, {Meghan G.} and Simard, {Marissa L.} and Christine Peterson and Sanjeev Bhalla and Pickhardt, {Perry J.} and Menias, {Christine O.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1148/rg.331125016",
language = "English (US)",
volume = "33",
pages = "155--173",
journal = "Radiographics",
issn = "0271-5333",
publisher = "Radiological Society of North America Inc.",
number = "1",

}

Lubner, MG, Simard, ML, Peterson, C, Bhalla, S, Pickhardt, PJ & Menias, CO 2013, 'Emergent and nonemergent nonbowel torsion: Spectrum of imaging and clinical findings', Radiographics, vol. 33, no. 1, pp. 155-173. https://doi.org/10.1148/rg.331125016

Emergent and nonemergent nonbowel torsion : Spectrum of imaging and clinical findings. / Lubner, Meghan G.; Simard, Marissa L.; Peterson, Christine; Bhalla, Sanjeev; Pickhardt, Perry J.; Menias, Christine O.

In: Radiographics, Vol. 33, No. 1, 01.01.2013, p. 155-173.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Emergent and nonemergent nonbowel torsion

T2 - Spectrum of imaging and clinical findings

AU - Lubner, Meghan G.

AU - Simard, Marissa L.

AU - Peterson, Christine

AU - Bhalla, Sanjeev

AU - Pickhardt, Perry J.

AU - Menias, Christine O.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Although bowel torsion is more commonly described in the medical literature, torsion can affect various organs within the chest, abdomen, and pelvis, including the testes, ovaries, gallbladder, spleen, heart, and pulmonary lobes. A structural abnormality such as a mass (a "lead point") that promotes twisting around a vascular pedicle often predisposes an organ or other anatomic structure to torsion. Radiologists play a central role in detecting torsion, identifying the anatomy involved, and triaging patients for either emergent surgical intervention, which may be critical for organ salvage, or conservative management. Imaging fndings that are suggestive or indicative of emergent torsion include an ectopic location and enlargement or edema of part or all of an organ, decreased blood fow at color Doppler ultrasonography, and a twisted vascular pedicle. Blood fow to an organ is quickly compromised by the constriction of vessels within the twisted pedicle, and ischemia may result; a delay in diagnosis and surgical treatment can lead to complications such as infarction, hemor-rhagic necrosis, and abscess. By contrast, torsion of mobile fatty structures such as testicular appendages, epiploic appendages, omental fat, and pericar-dial fat pads, although it may produce pain mimicking that in an emergent condition, requires only conservative management. Imaging features of this nonemergent condition include a fatty mass, which is usually located alongside the colon when torsion involves the omentum or an epiploic appendage, with associated infammatory stranding and tenderness at palpation. The radiologist should be familiar with these manifestations of nonemergent torsion to prevent unnecessary surgical intervention.

AB - Although bowel torsion is more commonly described in the medical literature, torsion can affect various organs within the chest, abdomen, and pelvis, including the testes, ovaries, gallbladder, spleen, heart, and pulmonary lobes. A structural abnormality such as a mass (a "lead point") that promotes twisting around a vascular pedicle often predisposes an organ or other anatomic structure to torsion. Radiologists play a central role in detecting torsion, identifying the anatomy involved, and triaging patients for either emergent surgical intervention, which may be critical for organ salvage, or conservative management. Imaging fndings that are suggestive or indicative of emergent torsion include an ectopic location and enlargement or edema of part or all of an organ, decreased blood fow at color Doppler ultrasonography, and a twisted vascular pedicle. Blood fow to an organ is quickly compromised by the constriction of vessels within the twisted pedicle, and ischemia may result; a delay in diagnosis and surgical treatment can lead to complications such as infarction, hemor-rhagic necrosis, and abscess. By contrast, torsion of mobile fatty structures such as testicular appendages, epiploic appendages, omental fat, and pericar-dial fat pads, although it may produce pain mimicking that in an emergent condition, requires only conservative management. Imaging features of this nonemergent condition include a fatty mass, which is usually located alongside the colon when torsion involves the omentum or an epiploic appendage, with associated infammatory stranding and tenderness at palpation. The radiologist should be familiar with these manifestations of nonemergent torsion to prevent unnecessary surgical intervention.

UR - http://www.scopus.com/inward/record.url?scp=84872533787&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872533787&partnerID=8YFLogxK

U2 - 10.1148/rg.331125016

DO - 10.1148/rg.331125016

M3 - Article

C2 - 23322835

AN - SCOPUS:84872533787

VL - 33

SP - 155

EP - 173

JO - Radiographics

JF - Radiographics

SN - 0271-5333

IS - 1

ER -