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

Acute presentation of endometriosis. Patient presented with intermenstrual vaginal bleeding and severe lower abdominal pain. a Transvaginal ultrasound demonstrates an ovarian cyst with an area of homogeneous internal echogenicity typical of an endometriotic cyst (black arrow). There is a focal area of clot retraction along the endometriotic cyst wall (white arrow). b Axial T1 image demonstrates bilateral complex adnexal cystic masses which contain high T1 material. c Axial T2 demonstrates intermediate signal intensity with ‘shading’ (black arrow), typical of endometriotic blood. The appearances are in keeping with bilateral haematosalpinges in a patient with endometriosis
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3369119&req=5

Fig3: Acute presentation of endometriosis. Patient presented with intermenstrual vaginal bleeding and severe lower abdominal pain. a Transvaginal ultrasound demonstrates an ovarian cyst with an area of homogeneous internal echogenicity typical of an endometriotic cyst (black arrow). There is a focal area of clot retraction along the endometriotic cyst wall (white arrow). b Axial T1 image demonstrates bilateral complex adnexal cystic masses which contain high T1 material. c Axial T2 demonstrates intermediate signal intensity with ‘shading’ (black arrow), typical of endometriotic blood. The appearances are in keeping with bilateral haematosalpinges in a patient with endometriosis

Mentions: Endometriosis is caused by cyclical bleeding of hormonally responsive endometrial cells present outside the uterine lining. This can lead to complications of blood-filled cysts within the ovaries (also known as endometriomas or ‘chocolate’ cysts) and haemorrhagic ascites leading to fibrosis and adhesions within the pelvis. Common presenting symptoms of this condition include chronic pelvic pain, dyspareunia, dysmenorrhoea and infertility [7, 13, 19]. Endometriosis involves the ovary in more than half the cases (up to 80%). On ultrasound, endometriomas have homogeneous low level echogenicity and give an appearance referred to as the “ground glass pattern” (Fig. 3a). In contrast to haemorrhagic cysts, endometriomas tend to be multiple and have a more stable appearance over time [20].Fig. 3


Radiological appearances of gynaecological emergencies.

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

Acute presentation of endometriosis. Patient presented with intermenstrual vaginal bleeding and severe lower abdominal pain. a Transvaginal ultrasound demonstrates an ovarian cyst with an area of homogeneous internal echogenicity typical of an endometriotic cyst (black arrow). There is a focal area of clot retraction along the endometriotic cyst wall (white arrow). b Axial T1 image demonstrates bilateral complex adnexal cystic masses which contain high T1 material. c Axial T2 demonstrates intermediate signal intensity with ‘shading’ (black arrow), typical of endometriotic blood. The appearances are in keeping with bilateral haematosalpinges in a patient with endometriosis
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Acute presentation of endometriosis. Patient presented with intermenstrual vaginal bleeding and severe lower abdominal pain. a Transvaginal ultrasound demonstrates an ovarian cyst with an area of homogeneous internal echogenicity typical of an endometriotic cyst (black arrow). There is a focal area of clot retraction along the endometriotic cyst wall (white arrow). b Axial T1 image demonstrates bilateral complex adnexal cystic masses which contain high T1 material. c Axial T2 demonstrates intermediate signal intensity with ‘shading’ (black arrow), typical of endometriotic blood. The appearances are in keeping with bilateral haematosalpinges in a patient with endometriosis
Mentions: Endometriosis is caused by cyclical bleeding of hormonally responsive endometrial cells present outside the uterine lining. This can lead to complications of blood-filled cysts within the ovaries (also known as endometriomas or ‘chocolate’ cysts) and haemorrhagic ascites leading to fibrosis and adhesions within the pelvis. Common presenting symptoms of this condition include chronic pelvic pain, dyspareunia, dysmenorrhoea and infertility [7, 13, 19]. Endometriosis involves the ovary in more than half the cases (up to 80%). On ultrasound, endometriomas have homogeneous low level echogenicity and give an appearance referred to as the “ground glass pattern” (Fig. 3a). In contrast to haemorrhagic cysts, endometriomas tend to be multiple and have a more stable appearance over time [20].Fig. 3

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