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Radiological appearances of gynaecological emergencies.

Roche O, Chavan N, Aquilina J, Rockall A - Insights Imaging (2012)

Bottom Line: Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone.Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT.MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion.

View Article: PubMed Central - PubMed

Affiliation: St Barts & The London NHS trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK, oran.roche@bartsandthelondon.nhs.uk.

ABSTRACT

Background: The role of various gynaecological imaging modalities is vital in aiding clinicians to diagnose acute gynaecological disease, and can help to direct medical and surgical treatment where appropriate. It is important to interpret the imaging findings in the context of the clinical signs and patient's pregnancy status.

Methods: Ultrasound and Doppler are readily available in the emergency department, and demonstrate features of haemorrhagic follicular cysts, ovarian cyst rupture, endometriotic cysts and pyosalpinx. Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone. Computed tomography (CT) is not routinely employed in diagnosing acute gynaecological complications. However due to similar symptoms and signs with gastrointestinal and urinary tract pathologies, it is frequently used as the initial imaging modality and recognition of features of gynaecological complications on CT is important.

Results: Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT.

Conclusion: MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion. In this article, we review the imaging appearances of gynaecological emergencies in non-pregnant patients.

Teaching points: • Ultrasonography is easily accessible and can identify life-threatening gynaecological complications. • Tomography scanners and computed radiography are not routinely used but are important to recognise key features. • MRI is used for the characterisation of acute gynaecological complications. • Recognition of the overlap in symptoms between gastrointestinal and gynaecological conditions is essential.

No MeSH data available.


Related in: MedlinePlus

Pelvic inflammatory disease with pyosalpinx on MRI. This patient presented to the emergency department with pyrexia, lower abdominal pain and diarrhoea. a Sagittal T2 image of the pelvis demonstrates multiple fluid-filled cystic structures within the right adnexa (black arrows). The complex cyst is thick walled and there is adjacent fat stranding. b Axial T2 image demonstrates bilateral tubo-ovarian abcesses. c Axial T1 fat-saturated image following gadolinium administration demonstrates low signal intensity within the pus-filled cavities and marked enhancement of the inflammatory walls. The imaging appearances may overlap with ovarian malignancy but the clinical presentation is of sepsis
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Fig10: Pelvic inflammatory disease with pyosalpinx on MRI. This patient presented to the emergency department with pyrexia, lower abdominal pain and diarrhoea. a Sagittal T2 image of the pelvis demonstrates multiple fluid-filled cystic structures within the right adnexa (black arrows). The complex cyst is thick walled and there is adjacent fat stranding. b Axial T2 image demonstrates bilateral tubo-ovarian abcesses. c Axial T1 fat-saturated image following gadolinium administration demonstrates low signal intensity within the pus-filled cavities and marked enhancement of the inflammatory walls. The imaging appearances may overlap with ovarian malignancy but the clinical presentation is of sepsis

Mentions: On MRI, inflammation in the parametrium may be seen as ill-defined hyperintense areas on T2-weighted fat-suppressed images, in addition to enhancement on gadolinium-enhanced T1-weighted images [37]. A pyosalpinx can be visualised as a dilated, fluid-filled, tortuous C or S-shaped structure. Thick-walled fluid-filled abscesses and pyosalpinx may have heterogeneous signal intensity on both T1 and T2 weighting due to mixtures of pus, haemorrhage and debris. The thick-walled mass typically demonstrates marked enhancement following iv gadolinium administration (Fig. 10c). Ovarian cancer should always be considered when investigating a possible tubo-ovarian mass. Although radiological features of abscess and ovarian malignancy can be similar, the clinical presentation plays an important role in establishing the diagnosis and follow-up imaging following treatment confirms decreasing size of adnexal massses [40, 41].Fig. 10


Radiological appearances of gynaecological emergencies.

Roche O, Chavan N, Aquilina J, Rockall A - Insights Imaging (2012)

Pelvic inflammatory disease with pyosalpinx on MRI. This patient presented to the emergency department with pyrexia, lower abdominal pain and diarrhoea. a Sagittal T2 image of the pelvis demonstrates multiple fluid-filled cystic structures within the right adnexa (black arrows). The complex cyst is thick walled and there is adjacent fat stranding. b Axial T2 image demonstrates bilateral tubo-ovarian abcesses. c Axial T1 fat-saturated image following gadolinium administration demonstrates low signal intensity within the pus-filled cavities and marked enhancement of the inflammatory walls. The imaging appearances may overlap with ovarian malignancy but the clinical presentation is of sepsis
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369119&req=5

Fig10: Pelvic inflammatory disease with pyosalpinx on MRI. This patient presented to the emergency department with pyrexia, lower abdominal pain and diarrhoea. a Sagittal T2 image of the pelvis demonstrates multiple fluid-filled cystic structures within the right adnexa (black arrows). The complex cyst is thick walled and there is adjacent fat stranding. b Axial T2 image demonstrates bilateral tubo-ovarian abcesses. c Axial T1 fat-saturated image following gadolinium administration demonstrates low signal intensity within the pus-filled cavities and marked enhancement of the inflammatory walls. The imaging appearances may overlap with ovarian malignancy but the clinical presentation is of sepsis
Mentions: On MRI, inflammation in the parametrium may be seen as ill-defined hyperintense areas on T2-weighted fat-suppressed images, in addition to enhancement on gadolinium-enhanced T1-weighted images [37]. A pyosalpinx can be visualised as a dilated, fluid-filled, tortuous C or S-shaped structure. Thick-walled fluid-filled abscesses and pyosalpinx may have heterogeneous signal intensity on both T1 and T2 weighting due to mixtures of pus, haemorrhage and debris. The thick-walled mass typically demonstrates marked enhancement following iv gadolinium administration (Fig. 10c). Ovarian cancer should always be considered when investigating a possible tubo-ovarian mass. Although radiological features of abscess and ovarian malignancy can be similar, the clinical presentation plays an important role in establishing the diagnosis and follow-up imaging following treatment confirms decreasing size of adnexal massses [40, 41].Fig. 10

Bottom Line: Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone.Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT.MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion.

View Article: PubMed Central - PubMed

Affiliation: St Barts & The London NHS trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK, oran.roche@bartsandthelondon.nhs.uk.

ABSTRACT

Background: The role of various gynaecological imaging modalities is vital in aiding clinicians to diagnose acute gynaecological disease, and can help to direct medical and surgical treatment where appropriate. It is important to interpret the imaging findings in the context of the clinical signs and patient's pregnancy status.

Methods: Ultrasound and Doppler are readily available in the emergency department, and demonstrate features of haemorrhagic follicular cysts, ovarian cyst rupture, endometriotic cysts and pyosalpinx. Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone. Computed tomography (CT) is not routinely employed in diagnosing acute gynaecological complications. However due to similar symptoms and signs with gastrointestinal and urinary tract pathologies, it is frequently used as the initial imaging modality and recognition of features of gynaecological complications on CT is important.

Results: Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT.

Conclusion: MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion. In this article, we review the imaging appearances of gynaecological emergencies in non-pregnant patients.

Teaching points: • Ultrasonography is easily accessible and can identify life-threatening gynaecological complications. • Tomography scanners and computed radiography are not routinely used but are important to recognise key features. • MRI is used for the characterisation of acute gynaecological complications. • Recognition of the overlap in symptoms between gastrointestinal and gynaecological conditions is essential.

No MeSH data available.


Related in: MedlinePlus