Abstract
Pelvic pain is one of the most common causes for presentation to the emergency department. A variety of gynecological processes may be the etiology for pelvic pain; hemorrhagic ovarian cysts, pelvic inflammatory disease, ovarian torsion, endometriosis, cystitis, ovarian vein thrombosis, and ovarian hyperstimulation syndrome are a few of the most commonly encountered pathologies. Before medical imaging is performed for evaluation of pelvic pain, it is important to obtain relevant clinical history and review available laboratory information. The patient’s age and pregnancy status are of particular importance in the differential diagnosis; therefore, serum beta-hCG laboratory evaluation is performed if there is even a remote possibility of pregnancy. Transvaginal and transabdominal ultrasound are the workhorse modalities for the evaluation of pelvic pain when a gynecological etiology is suspected. Transvaginal and/or transabdominal ultrasound are both considered equally appropriate when evaluating pelvic pain; this is true whether the serum beta-hCG is positive or negative and whether a gynecologic or nongynecologic etiology is suspected.
Similar content being viewed by others
References
Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, et al. Management of asymptomatic ovarian and other adnexal cysts imaged at US society of radiologists in ultrasound consensus conference statement. Ultrasound Q. 2010;26(3):121–31.
Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):711–24.
Tamai K, Koyama T, Saga T, Kido A, Kataoka M, Umeoka S, et al. MR features of physiologic and benign conditions of the ovary. Eur Radiol. 2006;16(12):2700–11.
Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Q. 2004;20(4):171–9.
Timor-Tritsch IE, Lerner JP, Monteagudo A, Murphy KE, Heller DS. Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol. 1998;12(1):56–66.
Lambert MJ, Villa M. Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am. 2004;22(3):683–96.
Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics. 2002;22(6):1327–34.
Kim SH, Kim SH, Yang DM, Kim KA. Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics. 2004;24(6):1575–89.
Singh AK, Desai H, Novelline RA. Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol. 2009;16(2):133–41.
Kilickesmez O, Tasdelen N, Yetimoglu B, Kayhan A, Cihangiroglu M, Gurmen N. Diffusion-weighted imaging of adnexal torsion. Emerg Radiol. 2009;16(5):399–401.
Woodward PJ, Sohaey R, Mezzetti TP Jr. Endometriosis: radiologic-pathologic correlation. Radiographics. 2001;21(1):193–216. questionnaire 288–94
Chamie LP, Blasbalg R, Pereira RMA, Warmbrand G, Serafini PC. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics. 2011;31(4):E77–100.
Marcal L, Nothaft MA, Coelho F, Choi H. Deep pelvic endometriosis: MR imaging. Abdom Imaging. 2010;35(6):708–15.
Bennett GL, Slywotzky CM, Cantera M, Hecht EM. Unusual manifestations and complications of endometriosis—spectrum of imaging findings: pictorial review. AJR Am J Roentgenol. 2010;194(6 Suppl):WS34–46.
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 2008;28(5):1355–68.
Chiou S-Y, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. J Ultrasound Med. 2007;26(10):1289–301.
Galinier P, Carfagna L, Delsol M, Ballouhey Q, Lemasson F, Le Mandat A, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44(9):1759–65.
Hiller N, Appelbaum L, Simanovsky N, Lev-Sagi A, Aharoni D, Sella T. CT features of adnexal torsion. AJR Am J Roentgenol. 2007;189(1):124–9.
Patel MD, Dubinsky TJ. Reimaging the female pelvis with ultrasound after CT. Ultrasound Q. 2007;23(3):177–87.
Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 2004;23(12):1643–9. quiz 1650–1
Rha SE, Byun JY, Jung SE, Jung JI, Choi BG, Kim BS, et al. CT and MR imaging features of adnexal torsion. Radiographics. 2002;22(2):283–94.
Johansen TEB. The role of imaging in urinary tract infections. World J Urol. 2004;22(5):392–8.
Blatt AH, Titus J, Chan L. Ultrasound measurement of bladder wall thickness in the assessment of voiding dysfunction. J Urol. 2008;179(6):2275–2278; discussion 2278–9.
Chang C-B, Chang C-C. Emphysematous cystitis: a rare cause of gross hematuria. J Emerg Med. 2011;40(5):506–8.
Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics. 2002;22(4):785–801.
Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 2009;19:222–31.
Dykes T, Siegel C, Dodson W. Imaging of congenital uterine anomalies: review and self-assessment module. AJR Am J Roentgenol. 2007;189(3):S1–10.
Kim TH, Lee HH, Chung SH. Presenting features of pyometra including an increase in iatrogenic causes. J Low Genit Tract Dis. 2011;15(4):316–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Malcolm, C., Khicha, A.R., Mansouri, M., Singh, A. (2018). Imaging of Acute Gynecologic Disorders. In: Singh, A. (eds) Emergency Radiology. Springer, Cham. https://doi.org/10.1007/978-3-319-65397-6_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-65397-6_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-65396-9
Online ISBN: 978-3-319-65397-6
eBook Packages: MedicineMedicine (R0)