Gynaecological vascular disorders: aetiology and characteristic imaging findings
Number:27ESURABS0037
Type:Educational Electronic Presentation
Authors: Ana Forjaco, Andreia Miguel, João Lopes Dias
Keywords:gynaecology, ischaemia, haemorrhage, vascular congestion
SECTIONS
Educational objective

To review clinical and imaging features of gynaecological disorders caused by different types of vascular compromise.

 

Topic Review

Gynaecological vascular conditions constitute a spectrum of pathologies that include different types of vascular compromise:

- ischaemic disorders, such as adnexal torsion;

- haemorrhagic episodes, for example, due to rupture of uterine arteriovenous malformations (UAVM);

- congestive vascular syndromes, such as ovarian vein thrombosis (OVT) and pelvic venous congestion syndrome (PVCS).

Most of them constitute known gynaecological emergencies, and it is essential to recognize their main clinical and imaging aspects in order to rapidly diagnose and treat them.

 

Clinically, these pathologies may course with:

(1) pelvic pain (with acute onset in adnexal torsion, and chronic development in PVCS);

(2) pelvic masses (typically in adnexal areas);

(3) other symptoms, such as nausea and vomiting in adnexal torsion,...

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Figure 1: Algorithmic approach to appropriate radiologic examinations in women who present to the emergency department with abdominopelvic pain and nausea. (Diagram adapted from Dawood A et al. Adnexal Torsion: Review of Radiologic Appearances. Radiographics (2021);41(2):609-624.)
Figure 2: Adnexal torsion in a 4-year-old girl who presented with left-sided loin pain and vomits. Focused transabdominal US image depicts an enlarged left ovary, with increased central echogenicity and some normal follicles within it. There was intra-operative confirmation of a twisted pedicle, with haemorrhagic ovarian alterations.
Conclusions

Diverse gynaecological conditions are provoked by ischemic, haemorrhagic or congestive organic disturbance. As most of them constitute known gynaecological emergencies, it is essential to recognize their clinical and imaging aspects, in a way to achieve a rapid diagnosis and treatment.