ABSTRACTThe clinical and radiologic diagnosis of adnexal torsion is challenging. The patient's history, physical examination, and laboratory evaluation may overlap significantly with other causes of abdominal pain. Ultrasound is the most common radiologic tool to assess for torsion, and the imaging findings can be equally equivocal. We present a case of adnexal torsion in an 18‐year‐old emergency room patient with abdominal pain, diagnosed by ultrasound based solely on an abnormal medial position of the ovary–a finding that has been only rarely mentioned in the literature, and never in isolation. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:578–580, 2015