CT imaging of gynecologic causes of acute pelvic pain: complementing ultrasound
Number:27ESURABS0070
Type:Educational Electronic Presentation
Authors: Filipe Alves, Margarida Morgado, Teresa Vilares, Beatriz Lima, Ana Duarte, Bruno Araújo, António Madureira
Keywords:Computed Tomography/CT. Acute pelvic pain. Gynecology.
SECTIONS
Educational objective

To review the Computed Tomography (CT) imaging of gynecologic causes of acute pelvic pain, focusing on:

  • Presenting the typical CT protocol for evaluation of acute pelvic pain in women;
  • Listing the differential diagnosis of acute pelvic pain in women;
  • Describing and illustrating the CT features of the main gynecologic causes of acute pelvic pain.

Topic Review

Acute pelvic pain in women is generally defined as pain of the lower abdomen or pelvis lasting for less than three months. It is a common presenting symptom to the emergency department and radiologist.

 

CT is important in the evaluation of women presenting with acute pelvic pain, due to its availability and to its acuity in differentiating gynecologic from non-gynecologic causes of acute pelvic pain; it may be performed if Ultrasound (US) findings are equivocal or if the abnormality extends beyond the field of view achievable with the endovaginal probe and further evaluation is required.

For CT evaluation of suspected female pelvic disease, it is essential to use intravenous contrast material - in single-section helical CT, it is recommended to administer 100-145 mL of 60% iodinated intravenous contrast material at a rate of 1,5-2 mL/sec with a scan delay...

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Fig. 1. Pelvic inflammatory disease: Axial inferior (A) and superior (B) views of a contrast-enhanced CT showing a uterus with indistinct borders (A), adjacent pelvic fat stranding/haziness (A), a right tubo-ovarian abcess (B; yellow arrow) and pyosalpinx (B; red arrow) and pelvic free fluid (B; purple arrow), suggestive of PID.
Fig. 2. Pelvic inflammatory disease: Axial view of a contrast-enhanced CT revealing inflammatory changes of the colon sigmoid (yellow arrow) secondary to involvement by PID manifesting with a left tubo-ovarian abcess, adjacent pelvic fat stranding/haziness and pelvic free fluid.


Conclusions

Although US is the imaging technique primarily used for the evaluation of women presenting with acute pelvic pain, CT does play an important role in this setting.

Radiologists should master the CT imaging of gynecologic causes of acute pelvic pain, in order to properly evaluate women presenting with this symptom.

 

Bibliography

Morgan, M., Jones, J. Acute pelvic pain. Reference article, Radiopaedia.org. (accessed on 24 Oct 2021) https://doi.org/10.53347/rID-33306

Bennett, G. L., Slywotzky, C. M., & Giovanniello, G. (2002). Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics: a review publication of the Radiological Society of North America, Inc, 22(4), 785-801. https://doi.org/10.1148/radiographics.22.4.g02jl18785

Radswiki, T., Marghany, B. Pelvic inflammatory disease....

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