Ovarian torsion reveals a large hemorrhagic cystadenofibroma in an elderly woman: Diagnostic challenges and imaging characteristics

A 61-year-old postmenopausal woman presented with abdominal edema, heaviness in the lower abdomen, and acute pain in the left lower quadrant. Imaging revealed a large mass with both cystic and solid components on the left side of the uterus, and torsion was suspected based on the coiled appearance of the ovarian pedicle, commonly referred to as the “spiral sign.” A diagnosis of hemorrhagic ovarian cystadenofibroma was made following emergency surgery, which included detorsion and left oophorectomy. This case highlights the diagnostic challenge posed by the resemblance of cystadenofibromas to malignant tumors on imaging. MRI proved crucial in differentiating the tumor's fibrous stroma from malignant characteristics, and the patient had a positive outcome postsurgery. The case underscores the importance of timely surgical intervention, especially in emergencies like ovarian torsion, and highlights the role of advanced imaging in guiding diagnosis and management.