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文献考察:卵巣捻転
１）【どこまでわかる?急性腹症のCT診断】 婦人科疾患
Author：安田晶信(湘南鎌倉総合病院 放射線科), 木幡豊
Source：画像診断(0285-0524)24巻5号 Page621-630(2004.04)
２）【女性生殖器疾患のminimum essential】 婦人科救急疾患
Author：藤井進也(鳥取大学医学部附属病院 放射線科), 木下俊文, 小川敏英, 鎌田憲子, 森岡伸夫, 仙田哲朗, 田原誉敏, 井隼孝司, 中西順子, 小山司, 矢田普作, 竹内薫, 佐藤誠也, 寺川直樹
Source：画像診断(0285-0524)23巻3号 Page271-279(2003.02)
３）Radiographics. 2002 Jul-Aug;22(4):785-801.
Gynecologic causes of acute pelvic pain: spectrum of CT findings.
Bennett GL, Slywotzky CM, Giovanniello G.
Although ultrasound (US) is the primary imaging modality of choice in the radiologic evaluation of the female patient with acute pelvic pain, the role of computed tomography (CT) in the evaluation of abdominal and pelvic pain continues to expand. CT may be performed if a gynecologic disorder is not initially suspected, if US findings are equivocal, or if the abnormality extends beyond the field of view achievable with the endovaginal probe and further characterization of pelvic disease is required. Many gynecologic disorders that cause acute pelvic pain (eg, uterine disorders, ovarian disorders, endometriosis, pelvic inflammatory disease, postoperative or postpartum complications) demonstrate characteristic CT findings. Familiarity with these CT appearances is important: It will allow the radiologist to guide appropriate treatment of affected patients and may eliminate the need for further imaging evaluation. PMID: 12110710
４） Radiol Clin North Am. 2004 Mar;42(2):329-48.
Adnexal mass with pelvic pain.
Webb EM, Green GE, Scoutt LM.
In a pregnant woman who presents with acute pelvic pain and an adnexal mass, pregnancy-related etiologies, such as ectopic pregnancy or ovarian torsion, are typically the first diagnoses to be considered. Many other causes of pelvic pain associated with an adnexal mass can occur in pregnant patients, however. Some causes are benign and others require urgent management and treatment. Clinical presentation and physical examination can be misleading in pregnancy. The location of pain may be atypical for the pathologic entity, the pain may be muted, and in the case of infection, fever and leukocytosis can be absent. US examination is a safe and effective method for evaluating these patients. Sonographic characterization of adnexal masses may make a definitive diagnosis or focus the differential, which allows for prompt and appropriate treatment of patients.PMID: 15136020
上記文献のまとめ：卵巣茎捻転は卵巣あるいは付属器全体が支持靱帯（固有卵巣索と卵巣提索）を軸として捻転するものであり，若年女性に多くみられる．周囲と癒着を生じにくい皮様嚢腫や機能性嚢胞，嚢胞性卵巣腫瘍（多くは6cm以上のもの）に生じやすく，小児においては付属器の固定が不十分で可動性に富むために，正常卵巣の茎捻転を起こすこともある．
捻転により卵巣の動静脈の血行障害が生じるため，初期には静脈のうっ滞が起こり卵巣の浮腫．腫大をきたす．さらに血腫を形成，虚血が進行すると組織が壊死に陥る．画像上はこれらの変化を反映し，捻転およびそれに伴う血行障害により卵管の腫大や捻転した嚢胞の壁肥厚（出血性梗塞で三日月状あるいはコンマ形），嚢胞内出血，腹水などが認められる．
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