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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

Cystic fibroid degeneration. This patient presented to the emergency department with vaginal bleeding and lower abdominal pain. a CT following iv contrast administration shows demarcated regions of low density within the fibroid representing cystic degeneration (black arrow) with enhancing surrounding soft tissue (white arrow) . These features are in keeping with degenerative change of a uterine fibroid. The differential diagnosis includes a complex ovarian mass. b Sagittal T2 MRI demonstrates a large heterogenous mass (white arrow) arising from the fundus of the uterus (black arrow). Cystic areas of degeneration are demonstrated by areas of high signal intensity within the fibroid. Identifying a connection to the uterus is important in making the correct diagnosis
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Fig5: Cystic fibroid degeneration. This patient presented to the emergency department with vaginal bleeding and lower abdominal pain. a CT following iv contrast administration shows demarcated regions of low density within the fibroid representing cystic degeneration (black arrow) with enhancing surrounding soft tissue (white arrow) . These features are in keeping with degenerative change of a uterine fibroid. The differential diagnosis includes a complex ovarian mass. b Sagittal T2 MRI demonstrates a large heterogenous mass (white arrow) arising from the fundus of the uterus (black arrow). Cystic areas of degeneration are demonstrated by areas of high signal intensity within the fibroid. Identifying a connection to the uterus is important in making the correct diagnosis

Mentions: In acute presentation of pain, fibroid degeneration on CT may show a cystic appearance of a fibroid mass, with reduced enhancement and hypodense areas. Fibroid degeneration can often be difficult to distinguish from cystic ovarian masses on CT and MRI is often needed to distinguish between them (Fig. 5a, b). MRI can be very helpful in this respect, when investigating suspected acute fibroid complications (Fig. 6a–c). The use of multiplanar views can enable localisation of fibroids and can make it possible to distinguish fibroids from ovarian masses. Fibroids that have undergone degeneration show a great diversity in their MRI appearances with cystic change and areas of non-enhancement. In cases of red degeneration, the patient often presents with an acute abdomen. MRI appearances show high signal intensity centrally within the fibroid on T1-weighted images consistent with blood, with reduced signal at the periphery on T2-weighted images secondary to haemosiderin deposition (Fig. 6a, b). There may be heterogeneous signal intensity on T2, with no enhancement post-gadolinium administration (although gadolinium is not given to pregnant patients) [36, 37].Fig. 5


Radiological appearances of gynaecological emergencies.

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

Cystic fibroid degeneration. This patient presented to the emergency department with vaginal bleeding and lower abdominal pain. a CT following iv contrast administration shows demarcated regions of low density within the fibroid representing cystic degeneration (black arrow) with enhancing surrounding soft tissue (white arrow) . These features are in keeping with degenerative change of a uterine fibroid. The differential diagnosis includes a complex ovarian mass. b Sagittal T2 MRI demonstrates a large heterogenous mass (white arrow) arising from the fundus of the uterus (black arrow). Cystic areas of degeneration are demonstrated by areas of high signal intensity within the fibroid. Identifying a connection to the uterus is important in making the correct diagnosis
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3369119&req=5

Fig5: Cystic fibroid degeneration. This patient presented to the emergency department with vaginal bleeding and lower abdominal pain. a CT following iv contrast administration shows demarcated regions of low density within the fibroid representing cystic degeneration (black arrow) with enhancing surrounding soft tissue (white arrow) . These features are in keeping with degenerative change of a uterine fibroid. The differential diagnosis includes a complex ovarian mass. b Sagittal T2 MRI demonstrates a large heterogenous mass (white arrow) arising from the fundus of the uterus (black arrow). Cystic areas of degeneration are demonstrated by areas of high signal intensity within the fibroid. Identifying a connection to the uterus is important in making the correct diagnosis
Mentions: In acute presentation of pain, fibroid degeneration on CT may show a cystic appearance of a fibroid mass, with reduced enhancement and hypodense areas. Fibroid degeneration can often be difficult to distinguish from cystic ovarian masses on CT and MRI is often needed to distinguish between them (Fig. 5a, b). MRI can be very helpful in this respect, when investigating suspected acute fibroid complications (Fig. 6a–c). The use of multiplanar views can enable localisation of fibroids and can make it possible to distinguish fibroids from ovarian masses. Fibroids that have undergone degeneration show a great diversity in their MRI appearances with cystic change and areas of non-enhancement. In cases of red degeneration, the patient often presents with an acute abdomen. MRI appearances show high signal intensity centrally within the fibroid on T1-weighted images consistent with blood, with reduced signal at the periphery on T2-weighted images secondary to haemosiderin deposition (Fig. 6a, b). There may be heterogeneous signal intensity on T2, with no enhancement post-gadolinium administration (although gadolinium is not given to pregnant patients) [36, 37].Fig. 5

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