Limits...
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

Rupture of a haemorrhagic cyst. Patient presented to the accident and emergency department with a 1-day history of acute right iliac fossa pain and diarrhoea. Initially the patient was diagnosed as having an appendicitis. a CT following iv contrast administration demonstrates bilateral low-density cystic lesions (white arrows). There is extensive hyperdense free pelvic fluid representing hemorrhagic ascites (black arrow). b Trans-abdominal ultrasound shows free fluid containing low level echoes in the pelvis (black arrow). There is an adnexal cyst in the pelvis representing the right haemorrhagic ovarian cyst (white arrow). The smaller right-sided cyst may be the site of rupture as the ruptured cyst may be small or difficult to visualize following rupture
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3369119&req=5

Fig2: Rupture of a haemorrhagic cyst. Patient presented to the accident and emergency department with a 1-day history of acute right iliac fossa pain and diarrhoea. Initially the patient was diagnosed as having an appendicitis. a CT following iv contrast administration demonstrates bilateral low-density cystic lesions (white arrows). There is extensive hyperdense free pelvic fluid representing hemorrhagic ascites (black arrow). b Trans-abdominal ultrasound shows free fluid containing low level echoes in the pelvis (black arrow). There is an adnexal cyst in the pelvis representing the right haemorrhagic ovarian cyst (white arrow). The smaller right-sided cyst may be the site of rupture as the ruptured cyst may be small or difficult to visualize following rupture

Mentions: Haemoperitoneum, a serious complication of ovarian haemorrhagic cyst rupture, may be demonstrated on both US and CT (Fig. 2a, b) and should necessitate urgent surgical intervention. In some cases, the original cyst may not be visible. On US, peritoneal or pelvic fluid is seen, with low level echoes. The cyst itself may have a crenated appearance [14]. On CT, the free peritoneal fluid has a relatively high attenuation and, on delayed CT images, there may be contrast-enhanced blood pooling in the pelvis. The limitations of CT are that it can often be difficult to identify the ovaries separately from surrounding anatomical structures. It can be challenging to distinguish whether a lesion arises from the adnexa or another structure like omentum. As ovarian haemorrhage usually affects women of reproductive age, there are also the risks associated with irradiating the pelvis [2].Fig. 2


Radiological appearances of gynaecological emergencies.

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

Rupture of a haemorrhagic cyst. Patient presented to the accident and emergency department with a 1-day history of acute right iliac fossa pain and diarrhoea. Initially the patient was diagnosed as having an appendicitis. a CT following iv contrast administration demonstrates bilateral low-density cystic lesions (white arrows). There is extensive hyperdense free pelvic fluid representing hemorrhagic ascites (black arrow). b Trans-abdominal ultrasound shows free fluid containing low level echoes in the pelvis (black arrow). There is an adnexal cyst in the pelvis representing the right haemorrhagic ovarian cyst (white arrow). The smaller right-sided cyst may be the site of rupture as the ruptured cyst may be small or difficult to visualize following rupture
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Rupture of a haemorrhagic cyst. Patient presented to the accident and emergency department with a 1-day history of acute right iliac fossa pain and diarrhoea. Initially the patient was diagnosed as having an appendicitis. a CT following iv contrast administration demonstrates bilateral low-density cystic lesions (white arrows). There is extensive hyperdense free pelvic fluid representing hemorrhagic ascites (black arrow). b Trans-abdominal ultrasound shows free fluid containing low level echoes in the pelvis (black arrow). There is an adnexal cyst in the pelvis representing the right haemorrhagic ovarian cyst (white arrow). The smaller right-sided cyst may be the site of rupture as the ruptured cyst may be small or difficult to visualize following rupture
Mentions: Haemoperitoneum, a serious complication of ovarian haemorrhagic cyst rupture, may be demonstrated on both US and CT (Fig. 2a, b) and should necessitate urgent surgical intervention. In some cases, the original cyst may not be visible. On US, peritoneal or pelvic fluid is seen, with low level echoes. The cyst itself may have a crenated appearance [14]. On CT, the free peritoneal fluid has a relatively high attenuation and, on delayed CT images, there may be contrast-enhanced blood pooling in the pelvis. The limitations of CT are that it can often be difficult to identify the ovaries separately from surrounding anatomical structures. It can be challenging to distinguish whether a lesion arises from the adnexa or another structure like omentum. As ovarian haemorrhage usually affects women of reproductive age, there are also the risks associated with irradiating the pelvis [2].Fig. 2

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