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

Pedunculated submucosal fibroid with prolapse and torsion. The patient presented to the emergency department with acute abdominal pain and vaginal bleeding. a Sagittal T2 image demonstrates a fibroid arising on a stalk (white arrow) that originates in the lower endometrial cavity. The fibroid has prolapsed into the endocervical canal (black arrow) and demonstrates areas of low T2 suggestive of haemorrhage. These features are typical of a pedunculated fibroid or polyp. b Axial T2 image demonstrates the torted fibroid (white arrow) surrounded by the ring of cervical stroma (black arrow). c Axial T1 fat-saturated image demonstrates high signal intensity within the fibroid indicating haemorrhage (black arrow). d Axial T1 fat-saturated image following gadolinium administration demonstrates lack of enhancement consistent with torsion (white arrow)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3369119&req=5

Fig7: Pedunculated submucosal fibroid with prolapse and torsion. The patient presented to the emergency department with acute abdominal pain and vaginal bleeding. a Sagittal T2 image demonstrates a fibroid arising on a stalk (white arrow) that originates in the lower endometrial cavity. The fibroid has prolapsed into the endocervical canal (black arrow) and demonstrates areas of low T2 suggestive of haemorrhage. These features are typical of a pedunculated fibroid or polyp. b Axial T2 image demonstrates the torted fibroid (white arrow) surrounded by the ring of cervical stroma (black arrow). c Axial T1 fat-saturated image demonstrates high signal intensity within the fibroid indicating haemorrhage (black arrow). d Axial T1 fat-saturated image following gadolinium administration demonstrates lack of enhancement consistent with torsion (white arrow)

Mentions: Submucosal pedunculated leiomyomas may prolapse through the cervical canal and even the vaginal canal, and typically present with pain and abnormal vaginal bleeding. A pedunculated submucosal leiomyoma may be detected on clinical gynaecological examination if there is prolapse into the vaginal canal. The role of imaging is in diagnosis of the lesion origin and identification of the stalk and the uterine attachment of the leiomyoma. MRI is the most effective imaging modality in the diagnosis of a prolapsed leiomyoma [38]. Sagittal T2-weighted images demonstrate the prolapsing leiomyoma extending into the endocervical canal, and frequently show the stalk and its uterine attachment (Fig. 7a). The stalk extends up into the endometrial cavity and typically has multiple linear structures running through it, and the appearance of the stalk and prolapsed fibroid has been described as the ‘broccoli sign’ [36]. The fibroid may become torted and haemorrhagic, and shows heterogeneous signal intensity on MRI, with lack of enhancement following contrast administration (Fig. 7). MRI can provide important clinical information for pre-surgical planning [38, 39].Fig. 7


Radiological appearances of gynaecological emergencies.

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

Pedunculated submucosal fibroid with prolapse and torsion. The patient presented to the emergency department with acute abdominal pain and vaginal bleeding. a Sagittal T2 image demonstrates a fibroid arising on a stalk (white arrow) that originates in the lower endometrial cavity. The fibroid has prolapsed into the endocervical canal (black arrow) and demonstrates areas of low T2 suggestive of haemorrhage. These features are typical of a pedunculated fibroid or polyp. b Axial T2 image demonstrates the torted fibroid (white arrow) surrounded by the ring of cervical stroma (black arrow). c Axial T1 fat-saturated image demonstrates high signal intensity within the fibroid indicating haemorrhage (black arrow). d Axial T1 fat-saturated image following gadolinium administration demonstrates lack of enhancement consistent with torsion (white arrow)
© Copyright Policy
Related In: Results  -  Collection

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

Fig7: Pedunculated submucosal fibroid with prolapse and torsion. The patient presented to the emergency department with acute abdominal pain and vaginal bleeding. a Sagittal T2 image demonstrates a fibroid arising on a stalk (white arrow) that originates in the lower endometrial cavity. The fibroid has prolapsed into the endocervical canal (black arrow) and demonstrates areas of low T2 suggestive of haemorrhage. These features are typical of a pedunculated fibroid or polyp. b Axial T2 image demonstrates the torted fibroid (white arrow) surrounded by the ring of cervical stroma (black arrow). c Axial T1 fat-saturated image demonstrates high signal intensity within the fibroid indicating haemorrhage (black arrow). d Axial T1 fat-saturated image following gadolinium administration demonstrates lack of enhancement consistent with torsion (white arrow)
Mentions: Submucosal pedunculated leiomyomas may prolapse through the cervical canal and even the vaginal canal, and typically present with pain and abnormal vaginal bleeding. A pedunculated submucosal leiomyoma may be detected on clinical gynaecological examination if there is prolapse into the vaginal canal. The role of imaging is in diagnosis of the lesion origin and identification of the stalk and the uterine attachment of the leiomyoma. MRI is the most effective imaging modality in the diagnosis of a prolapsed leiomyoma [38]. Sagittal T2-weighted images demonstrate the prolapsing leiomyoma extending into the endocervical canal, and frequently show the stalk and its uterine attachment (Fig. 7a). The stalk extends up into the endometrial cavity and typically has multiple linear structures running through it, and the appearance of the stalk and prolapsed fibroid has been described as the ‘broccoli sign’ [36]. The fibroid may become torted and haemorrhagic, and shows heterogeneous signal intensity on MRI, with lack of enhancement following contrast administration (Fig. 7). MRI can provide important clinical information for pre-surgical planning [38, 39].Fig. 7

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