Poster électronique

Torsion d'annexe : la fin d'un mythe ?
E. Defasque, M. Lernout, N. Laurent, P. Collinet, D. Vinatier, N. Coutty, E. Poncelet - Lille - France
Congrès 2009
Résumé
Objectifs
Evaluer la fréquence des torsions d'annexe sans kyste sous-jacent. Rappeler la séméiologie radiologique et les pièges diagnostiques.
Matériels et méthodes
Etude rétrospective sur 18 suspicions de torsion d'annexe en imagerie chez des patientes âgées de 10 à 55 ans (moyenne : 32 ans), dont 5 enceintes. Toutes ont bénéficié d'une échographie et 10 d'une IRM en urgence dans le service. L'histoire clinique, la séméiologie radiologique, le résultat opératoire et anatomopathologique ont été analysés.
Résultats
Cinq patientes présentaient une suspicion clinique de torsion d'annexe. Sur 15 torsions confirmées au bloc opératoire, 10 sont survenues sur ovaires sains, 2 sur kyste dermoïde, 2 sur fibrothécome, et 1 sur kyste du para-ovaire. Une torsion typique en imagerie n'a pas été confirmée histologiquement en raison de l'absence de prise en charge thérapeutique. L'IRM était responsable de 2 faux positifs : les aspects trompeurs sont l'endométriose et la femme enceinte (veines dilatées) et 1 faux négatif : torsion de fibrome ovarien (diagnostic initial : myome sous-séreux pédiculé en nécrobiose). Dans 2 cas, un pronostic ovarien défavorable était suspecté en IRM sur des plages nécrotico-hémorragiques, confirmé en histologie.
Conclusion
73 % des torsions surviennent sur ovaires sains. Dans notre étude, l'imagerie a permis de diagnostiquer 13 torsions non suspectées à l'examen clinique.
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2017-04-11 11.38 :
Ann Tabares

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