Pseudo-Bladder and Double-Bladder Signs Suggestive of Pediatric Ovarian Torsion Associated With Pelvic Cystic Lesions: A Case Series.

Ovarian torsion is a rare but serious cause of acute abdominal pain in female children, and delayed diagnosis can result in infertility. In this case series of five pediatric patients, we report a case in which point-of-care ultrasound demonstrated a unique finding that we refer to as the "pseudo-bladder sign." In this case, a collapsed bladder led to the misidentification of an ovarian cyst as the bladder, contributing to a delayed diagnosis of ovarian torsion. To provide a clearer understanding of this phenomenon, we additionally present four cases in which radiology-performed ultrasound demonstrated the "double-bladder sign," where a cyst simulated a second bladder. Although these signs indicate the presence of a pelvic cyst rather than torsion itself, they may serve as a diagnostic clue for ovarian torsion when accompanied by acute abdominal pain. Recognition of these findings, combined with accurate knowledge of female pelvic anatomy and systematic scanning in transverse and longitudinal planes, may facilitate earlier diagnosis, help prevent diagnostic delays, and potentially reduce the risk of ovarian loss.