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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

Haemorrhagic cyst. Patient presented to the emergency department with acute onset of lower abdominal pain. The patient had a previous history of a right oophorectomy for an ovarian serous tumour. Transvaginal ultrasound of the left ovary demonstrates a cyst with typical lacelike reticular internal echoes (large white arrow). There is no internal blood flow but circumferential blood flow around the cyst wall is seen (small white arrow); this is a typical feature in a haemorrhagic corpus luteal cyst
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Fig1: Haemorrhagic cyst. Patient presented to the emergency department with acute onset of lower abdominal pain. The patient had a previous history of a right oophorectomy for an ovarian serous tumour. Transvaginal ultrasound of the left ovary demonstrates a cyst with typical lacelike reticular internal echoes (large white arrow). There is no internal blood flow but circumferential blood flow around the cyst wall is seen (small white arrow); this is a typical feature in a haemorrhagic corpus luteal cyst

Mentions: A transvaginal ultrasound is often the first imaging modality in patients who are suspected of having an ovarian cyst haemorrhage. When there is an intracystic haemorrhage the characteristics of the bleed evolve with its age. In the acute stage, the haemorrhage is isoechoic in relation to the ovarian stroma and this can often be similar in appearance to an enlarged ovary. As the clot forms, with time the fibrin strands give a typical reticular fine ‘lacy net’ or ‘spider web’ pattern (Fig. 1). Sometimes a fluid debris level may also be seen and often, as the clot matures, it may attach to the wall of the cyst, giving it a thick-walled appearance [2, 5, 7]. The use of Doppler is often used to help distinguish between malignant and benign ovarian cysts. Doppler US may demonstrate the vascular wall and the avascular internal lace-like appearances of a haemorrhagic corpus luteum cyst [8]. When performing ultrasound, it is important to exclude the presence of intraperitoneal fluid in order to exclude haemorrhagic cyst rupture. However, ultrasound has its limitations in trying to identify whether a haematoma is originating from the fallopian tube or from the ovary. In addition, the nonspecific characteristics of the presenting pain can often make CT a more attractive first investigation in the acute setting as it can exclude other intra-abdominal causes.Fig. 1


Radiological appearances of gynaecological emergencies.

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

Haemorrhagic cyst. Patient presented to the emergency department with acute onset of lower abdominal pain. The patient had a previous history of a right oophorectomy for an ovarian serous tumour. Transvaginal ultrasound of the left ovary demonstrates a cyst with typical lacelike reticular internal echoes (large white arrow). There is no internal blood flow but circumferential blood flow around the cyst wall is seen (small white arrow); this is a typical feature in a haemorrhagic corpus luteal cyst
© Copyright Policy
Related In: Results  -  Collection

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

Fig1: Haemorrhagic cyst. Patient presented to the emergency department with acute onset of lower abdominal pain. The patient had a previous history of a right oophorectomy for an ovarian serous tumour. Transvaginal ultrasound of the left ovary demonstrates a cyst with typical lacelike reticular internal echoes (large white arrow). There is no internal blood flow but circumferential blood flow around the cyst wall is seen (small white arrow); this is a typical feature in a haemorrhagic corpus luteal cyst
Mentions: A transvaginal ultrasound is often the first imaging modality in patients who are suspected of having an ovarian cyst haemorrhage. When there is an intracystic haemorrhage the characteristics of the bleed evolve with its age. In the acute stage, the haemorrhage is isoechoic in relation to the ovarian stroma and this can often be similar in appearance to an enlarged ovary. As the clot forms, with time the fibrin strands give a typical reticular fine ‘lacy net’ or ‘spider web’ pattern (Fig. 1). Sometimes a fluid debris level may also be seen and often, as the clot matures, it may attach to the wall of the cyst, giving it a thick-walled appearance [2, 5, 7]. The use of Doppler is often used to help distinguish between malignant and benign ovarian cysts. Doppler US may demonstrate the vascular wall and the avascular internal lace-like appearances of a haemorrhagic corpus luteum cyst [8]. When performing ultrasound, it is important to exclude the presence of intraperitoneal fluid in order to exclude haemorrhagic cyst rupture. However, ultrasound has its limitations in trying to identify whether a haematoma is originating from the fallopian tube or from the ovary. In addition, the nonspecific characteristics of the presenting pain can often make CT a more attractive first investigation in the acute setting as it can exclude other intra-abdominal causes.Fig. 1

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