Although ovarian torsion is rare in children, it is frequently mis- diagnosed in the broad differential diagnosis of its major present- ing symptom: abdominal pain. In addition to the pain that ovarian torsion causes, when left untreated, ovarian torsion represents a significant threat to the future fertility of girls. This review looks at the evidence on diagnosing ovarian torsion, focusing particularly on diagnostic imaging modalities and the major guideline recommenda- tions to effectively differentiate ovarian torsion from the many other possible causes of abdominal pain in the pediatric female. Literature regarding the relevance of symptom duration in the prediction of ovarian salvageability is discussed as well as recurrence, complica- tions, and conservative operative management. A combination of findings from the history, the physical examination, and ultrasound imaging will guide emergency clinicians in prompt and effective surgical referrals for ovarian torsion, offering patients the best hope to avoid morbidity.