Pediatric emergency medicine trisk 2144 2144
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for adnexal torsion, a pelvic ultrasound with Doppler is the first study of choice.
Of note, patients will need to have a full bladder to allow visualization of the
ovaries on ultrasound. While a wide spectrum of morphologic changes have been
reported on ultrasound, the majority of patients will have a unilaterally enlarged
ovary. Because torsion can be an intermittent process, the presence of arterial
blood flow does not rule out the diagnosis of adnexal torsion. However, the
absence of Doppler flow is highly suggestive of torsion. While computed
tomography can demonstrate findings consistent with adnexal torsion, it is used
most commonly when alternative diagnoses are suspected. Similarly, while
magnetic resonance imaging (MRI) can diagnose torsion, the logistical difficulty
of obtaining the study in many centers, combined with the high cost and potential
delay in diagnosis, limits its utility for this diagnosis.
Management
As with all patients presenting with a potential surgical diagnosis, patients with
suspected adnexal torsion should remain NPO, have an IV placed, and be
provided intravenous fluids. Pain management with opioids may be needed. If the
diagnosis of adnexal torsion is confirmed, the patient should be assessed
immediately by a surgeon for further management.
DISEASES THAT PRODUCE EXTERNAL GENITOURINARY
LESIONS
CLINICAL PEARLS AND PITFALLS
HSV may not present with classic symptoms making laboratory testing
essential.
Primary HSV infections are typically characterized by more lesions and
greater systemic involvement.
Human papillomavirus (HPV) affects the majority of young women in
some populations.
Herpes Simplex Virus Infection
HSV can cause disease of the skin, mucus membranes including genitalia, eyes,
liver, lung, and the central nervous system. Genital lesions can be caused by
either serotype of HSV (HSV-1 or HSV-2). Patients may present with any of the
three disease states of HSV: primary, nonprimary first episode, and recurrent. A
patient with HSV infection without pre-existing antibodies to HSV-1 or HSV-2
