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

Pelvic inflammatory disease with pyosalpinx on ultrasound. This patient presented to the emergency department with lower abdominal pain, pyrexia and vomiting. a–b Transvaginal ultrasound of both adenexa. There are bilateral adenexal cysts that contain low-level echogenic material and have a tubular configuration (white arrows). The appearance is in keeping with bilateral pyosalpinges, a complication of pelvic inflammatory disease
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3369119&req=5

Fig8: Pelvic inflammatory disease with pyosalpinx on ultrasound. This patient presented to the emergency department with lower abdominal pain, pyrexia and vomiting. a–b Transvaginal ultrasound of both adenexa. There are bilateral adenexal cysts that contain low-level echogenic material and have a tubular configuration (white arrows). The appearance is in keeping with bilateral pyosalpinges, a complication of pelvic inflammatory disease

Mentions: In the early phase of infection, it is common for ultrasound and CT appearances to be normal. As the disease advances, transabdominal ultrasound can demonstrate uterine enlargement and thickening of the endometrium. Ultrasound can also show the loss of tissue plains and an ill-defined uterus. Hydrosalpinx or pyosalpinx is a common complication of salpingitis. Ultrasound can identify dilated fallopian tubes containing heterogenous fluid with echogenic debris; features typical of pyosalpinx. The fallopian tubes may be folded and demonstrate areas of tube tapering, and intraluminal small linear echogenic foci may be visualised (Fig. 8a, b). As pyosalpinx develops into tubo-ovarian abscesses, echogenic debris can be seen in the fallopian tubes and ovaries, representing inflammatory exudates, blood and pus [37].Fig. 8


Radiological appearances of gynaecological emergencies.

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

Pelvic inflammatory disease with pyosalpinx on ultrasound. This patient presented to the emergency department with lower abdominal pain, pyrexia and vomiting. a–b Transvaginal ultrasound of both adenexa. There are bilateral adenexal cysts that contain low-level echogenic material and have a tubular configuration (white arrows). The appearance is in keeping with bilateral pyosalpinges, a complication of pelvic inflammatory disease
© Copyright Policy
Related In: Results  -  Collection

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

Fig8: Pelvic inflammatory disease with pyosalpinx on ultrasound. This patient presented to the emergency department with lower abdominal pain, pyrexia and vomiting. a–b Transvaginal ultrasound of both adenexa. There are bilateral adenexal cysts that contain low-level echogenic material and have a tubular configuration (white arrows). The appearance is in keeping with bilateral pyosalpinges, a complication of pelvic inflammatory disease
Mentions: In the early phase of infection, it is common for ultrasound and CT appearances to be normal. As the disease advances, transabdominal ultrasound can demonstrate uterine enlargement and thickening of the endometrium. Ultrasound can also show the loss of tissue plains and an ill-defined uterus. Hydrosalpinx or pyosalpinx is a common complication of salpingitis. Ultrasound can identify dilated fallopian tubes containing heterogenous fluid with echogenic debris; features typical of pyosalpinx. The fallopian tubes may be folded and demonstrate areas of tube tapering, and intraluminal small linear echogenic foci may be visualised (Fig. 8a, b). As pyosalpinx develops into tubo-ovarian abscesses, echogenic debris can be seen in the fallopian tubes and ovaries, representing inflammatory exudates, blood and pus [37].Fig. 8

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