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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

Torsion of an ovarian mass. Patient with a history of gastric cancer developed lower abdominal discomfort and attended for CT (a), which demonstrates bilateral solid/cystic complex adnexal masses consistent with ovarian metastases. Two months later she presented to the emergency department with acute onset of right iliac fossa pain with nausea and MRI of the pelvis was performed (b–d). b Sagittal T2-weighted image demonstrates marked enlargement of the right ovary with high T2 signal intensity in keeping with stromal oedema (white arrow). c Axial T1 image with fat saturation shows central low signal intensity (white arrow) surrounded a rim of high signal intensity in the enlarged right ovary consistent with peripheral haemorrhage (black arrow). d Axial T1 fat sat image following gadolinium administration confirms lack of enhancement of the right ovary (black arrow consistent with right ovarian torsion). The left ovarian metastasis enhances avidly (white arrow)
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Fig4: Torsion of an ovarian mass. Patient with a history of gastric cancer developed lower abdominal discomfort and attended for CT (a), which demonstrates bilateral solid/cystic complex adnexal masses consistent with ovarian metastases. Two months later she presented to the emergency department with acute onset of right iliac fossa pain with nausea and MRI of the pelvis was performed (b–d). b Sagittal T2-weighted image demonstrates marked enlargement of the right ovary with high T2 signal intensity in keeping with stromal oedema (white arrow). c Axial T1 image with fat saturation shows central low signal intensity (white arrow) surrounded a rim of high signal intensity in the enlarged right ovary consistent with peripheral haemorrhage (black arrow). d Axial T1 fat sat image following gadolinium administration confirms lack of enhancement of the right ovary (black arrow consistent with right ovarian torsion). The left ovarian metastasis enhances avidly (white arrow)

Mentions: Adnexal torsion is the rotation of at least one turn of the ovaries, adnexa or the fallopian tube around the line of the tubo-ovarian ligament and the infundibulopelvic ligament [24]. It is a diagnosis that should be considered when evaluating female patients presenting to the emergency services with lower abdominal pain. Risk factors for the development of adnexal torsion include ovarian tumours (Fig. 4a) and ovarian cysts. It is important that adnexal torsion is diagnosed early as delay can lead to complications such as loss of adnexa or the ovary with the associated fertility problems. In rare cases, diagnostic delay can cause peritonitis or fatal thrombophlebitis. Initial misdiagnosis of adnexal torsion is common and studies have shown that only 23% to 66% of cases are given the correct presurgical diagnosis [25, 26].Fig. 4


Radiological appearances of gynaecological emergencies.

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

Torsion of an ovarian mass. Patient with a history of gastric cancer developed lower abdominal discomfort and attended for CT (a), which demonstrates bilateral solid/cystic complex adnexal masses consistent with ovarian metastases. Two months later she presented to the emergency department with acute onset of right iliac fossa pain with nausea and MRI of the pelvis was performed (b–d). b Sagittal T2-weighted image demonstrates marked enlargement of the right ovary with high T2 signal intensity in keeping with stromal oedema (white arrow). c Axial T1 image with fat saturation shows central low signal intensity (white arrow) surrounded a rim of high signal intensity in the enlarged right ovary consistent with peripheral haemorrhage (black arrow). d Axial T1 fat sat image following gadolinium administration confirms lack of enhancement of the right ovary (black arrow consistent with right ovarian torsion). The left ovarian metastasis enhances avidly (white arrow)
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Related In: Results  -  Collection

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Fig4: Torsion of an ovarian mass. Patient with a history of gastric cancer developed lower abdominal discomfort and attended for CT (a), which demonstrates bilateral solid/cystic complex adnexal masses consistent with ovarian metastases. Two months later she presented to the emergency department with acute onset of right iliac fossa pain with nausea and MRI of the pelvis was performed (b–d). b Sagittal T2-weighted image demonstrates marked enlargement of the right ovary with high T2 signal intensity in keeping with stromal oedema (white arrow). c Axial T1 image with fat saturation shows central low signal intensity (white arrow) surrounded a rim of high signal intensity in the enlarged right ovary consistent with peripheral haemorrhage (black arrow). d Axial T1 fat sat image following gadolinium administration confirms lack of enhancement of the right ovary (black arrow consistent with right ovarian torsion). The left ovarian metastasis enhances avidly (white arrow)
Mentions: Adnexal torsion is the rotation of at least one turn of the ovaries, adnexa or the fallopian tube around the line of the tubo-ovarian ligament and the infundibulopelvic ligament [24]. It is a diagnosis that should be considered when evaluating female patients presenting to the emergency services with lower abdominal pain. Risk factors for the development of adnexal torsion include ovarian tumours (Fig. 4a) and ovarian cysts. It is important that adnexal torsion is diagnosed early as delay can lead to complications such as loss of adnexa or the ovary with the associated fertility problems. In rare cases, diagnostic delay can cause peritonitis or fatal thrombophlebitis. Initial misdiagnosis of adnexal torsion is common and studies have shown that only 23% to 66% of cases are given the correct presurgical diagnosis [25, 26].Fig. 4

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