Acute pelvic pain in female patient: Clinical and Radiological evaluation

Transcription

1 Acute pelvic pain in female patient: Clinical and Radiological evaluation Poster No.: C-0909 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit N. Ramesh 1, T. Simelane 2 ; 1 Portlaoise/IE, 2 Dublin/IE Emergency, Genital / Reproductive system female, Pelvis, Ultrasound, CT, MR, Comparative studies, Contrast agentintravenous, Intrauterine diagnosis, Education and training /ecr2014/C-0909 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 19

2 Learning objectives The learning objectives of this poster is to provide a clinical and Radiological triage of female patients presenting with acute pelvic pain Background Traditionally transabdominal ultrasound was the first and foremost method in evaluation of acute pelvic pain in female patients. Transvaginal ultrasound is increasingly regarded as an extension of a bimanual physical pelvic examination in the investigation of gynaecological and non-gynaecological cause of pelvic pain Findings and procedure details Acute pelvic pain in female patients can range from a less alarming rupture of the follicular cyst to life threatening conditions The causes can divided as listed below and depending of the severity and duration of the pain appropriate imaging protocol is undertaken. Ultrasound is the best and initial screening tool in evaluation. In age appropriate and in clinical conditions, endovaginal scan is better in evaulation of gynaecological causes Gynaecological/Obstetric causes Rupture follicular cysts Ovarian torsion Degenerating fibroids Ectopic pregnancy Endometriosis Pelvic inflammatory disease: Figure 13 Page 2 of 19

3 Ruptured dermoid cyst: Figure 5 Urological causes Cystitis: Recurrent/Radiation/Interstitial Urolithiasis: Figure 6 Bladder diverticulum/urethral diverticulum Hernia: Figure 4 Neoplasm Gastrointestinal causes Pelvic appendix- inflammation: Figure 1 & 2 Colitis Diverticular disease and complications: Figure 7 Inflammatory bowel disease Constipation Malignant lesions Musculoskeletal causes Fractures including insufficiency: Figure 14 Skeletal benign and malignant lesions: Figure 12 Groin pain Hernias: Figure 11 Miscellaneous Neurological causes Page 3 of 19

4 Disk herniation Nerve entrapment Benign and malignant lesions spinal/sacral nerves Although ultrasound and magnetic resonance imaging remain the primary imaging modalities for evaluating female patients with suspected acute pelvic pain. CT is now frequently performed as the initial imaging modality in the evaluation of abdominal and pelvic pain of unknown etiology. Pelvic pain in women due to a gynecologic condition may also mimic numerous other conditions such as appendicitis and diverticulitis and other causes listed above In our Hospital, ultrasound is the initially used to assess the patient and inconclusive cases or patients with continuing pain are referred to either MRI or CT depending on the clinical history and severity of pelvic pain Images for this section: Page 4 of 19

5 Fig. 1: CT Abdomen and pelvis Page 5 of 19

6 Fig. 2: Inflamed appendix extending to the midline and pelvis Page 6 of 19

7 Fig. 3: Displaced IUCD Fig. 4: Herniation of the bladder into the inguinal region Page 7 of 19

8 Fig. 5: Rupture of the dermoid cyst with calcification Page 8 of 19

9 Fig. 6: Bladder calculus Page 9 of 19

10 Fig. 7: Complicated diverticular disease with colo-vesical fistula Page 10 of 19

11 Fig. 8: Multiple pelvic abscesses and a dermoid cyst Page 11 of 19

12 Fig. 9: Ectopic right kidney in the pelvis,malrotated left kidney Page 12 of 19

13 Fig. 10: Left ovarian thrombus extending up to the left renal vein following miscarriage Page 13 of 19

14 Fig. 11: Obturator hernia on the right Page 14 of 19

15 Fig. 12: Sacral metastatic lesion from a breast primary Page 15 of 19

16 Fig. 13: Right hydrosalpinx and left dermoid cyst Page 16 of 19

17 Fig. 14: Healing fracture right pubic ramus Page 17 of 19

18 Conclusion Although ultrasound is the primary imaging modality of choice in evaluation of acute pelvic pain in a female patient, CT and MRI are helpful in difficult and challengeling cases It is important to consider ultrasound and other imaging appearances in conjunction with patient's clinical history and clinical findings since the causes of pelvic pain are many and varied. Personal information N Ramesh Consultant Radiologist Midland Regional Hospital Portlaoise, Ireland T Simelane, Consultant Radiologist Kerry General Hospital Kerry, Ireland References 1. US and CT evaluation of acute pelvic pain of gynecologic origin in non-pregnant premenopausal patients, Potter AW et al; Radiographics ; 2008 Oct; 28(6): doi: /rg Gynecologic causes of acute pelvic pain: spectrum of CT findings. Bennett GL et al: Radiographics; 2002 Jul-Aug; 22(4): Page 18 of 19

19 3. Role of multidetector CT in the management of acute female pelvic disease; Cano Alonso R et al; Emerg Radiol : 2009 Nov; 16(6): doi: /s Multidetector CT of the female pelvis, Siddall K; Radiol Clin North Am Nov; 43(6): , ix. Page 19 of 19