This poster was previously presented in Spanish at the 2010 Congreso Nacional SERAM (A Coruña)
Type:
Educational Exhibit
Keywords:
Abdomen, Emergency, Genital / Reproductive system female, CT, Computer Applications-General, Acute
Authors:
B. Bandres Carballo, L. Del Campo del Val, A. Mingo Basail, M. Velasco, I. Gallego, B. González; Madrid/ES
DOI:
10.1594/ecr2012/C-1444
Background
Although Ultrasound (US) and Magnetic Resonance are the imaging techniques of choice for suspected gynecological and obstetrical pathology,
MDCT is performed with increasing frequency as the initial imaging test for patients presenting to the emergency room with acute or chronic pelvic pain or pelvic mass of unknown cause.
In some cases,
CT is chosen to evaluate potential bowel or ureteral sources of pain; in others,
CT is chosen as the first test because it is readily available and decreases the perceived need for the clinician to make an educated guess as to whether the patient’s symptoms are likely due to gynecologic or nongynecologic causes.
The radiologist should,
therefore,
be familiar with the spectrum of gynecologic and obstetric pathology that may be present on a CT evaluation of the abdomen and pelvis regardless of the study indication.
This familiarity is especially valuable to enable imagers to properly apply general principles for when reimaging with US would and would not be useful.
Ectopic pregnancy,
pelvic inflammatory disease,
and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain.
Ovarian torsion and degenerating fibroids occur less frequently.
Other causes to consider include endometriosis,
and postpartum causes such as endometritis,
or ovarian vein thrombosis.
MDCT may help in diagnosing these patients discarding the gynecological origin (when the gynecological structures have a normal appearance) or confirming it when the radiological findings demonstrate the presence of functional or hemorrhagic ovarian cysts,
pelvic inflammatory disease,
hydrosalpinx,
ovarian tumors,
uterine fibroids or pelvic varicose veins.
If ovarian torsion is suspected,
the presence of certain findings on CT may obviate confirmatory US as well as to assist in diagnosis when the sonographic findings are nonspecific.
CT can also be useful in the diagnosis of ectopic pregnancy if it identifies hemoperitoneum and an adnexal cystic lesion and is indicated for diagnosis of pastpartum complications