A 35-year-old woman presented at 28 weeks of pregnancy with acute right-lower-quadrant abdominal pain and tenderness. Ultrasound examination was inconclusive. Magnetic resonance imaging (MRI) showed a fat-containing mass on the right ovary (Fig. 1), with twisting and enlargement of its vascular pedicle, consistent with torsion of a dermoid cyst. Diagnosis was confirmed during emergency surgery. The assessment of acute abdominal pain during pregnancy is challenging. Clinical and laboratory evaluation is often unhelpful; imaging is required for appropriate diagnosis and to facilitate treatment. Generally, ultrasound is performed initially, owing to its safety, availability, and low cost. However, the efficacy of ultrasound during pregnancy is hindered by technical difficulties such as poor penetration caused by increased abdominal girth, and image obscuration by the gravid uterus. When ultrasound is inconclusive, alternative imaging is required. Computed tomography (CT) can be used but its desirability is questionable because it exposes the fetus to ionizing radiation.
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