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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

Pelvic inflammatory disease with pyosalpinx on CT. This patient presented to the accident and emergency department with abdominal pain and pyrexia. She had a raised white cell count and CRP. The clinicians suspected an intra-abdominal collection. a CT demonstrates bilateral adnexal complex fluid-filled and thick-walled cysts typical for tubo-ovarian abcess formation, a complication of pelvic inflammatory disease. b Coronal reformat of the CT demonstrates bilateral tubo-ovarian abcesses as well as distention of multiple bowel loops due to an associated ileus
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Fig9: Pelvic inflammatory disease with pyosalpinx on CT. This patient presented to the accident and emergency department with abdominal pain and pyrexia. She had a raised white cell count and CRP. The clinicians suspected an intra-abdominal collection. a CT demonstrates bilateral adnexal complex fluid-filled and thick-walled cysts typical for tubo-ovarian abcess formation, a complication of pelvic inflammatory disease. b Coronal reformat of the CT demonstrates bilateral tubo-ovarian abcesses as well as distention of multiple bowel loops due to an associated ileus

Mentions: In order to reduce exposure to radiation, CT is not usually employed as a first-line imaging investigation in cases of suspected PID. The CT appearances of PID are often non-specific with parapelvic fat stranding, a small volume of free fluid and thickened uterosacral ligaments. However, the development of tubo-ovarian abscesses results in thickened irregularly enhancing complex adnexal masses with thick walls and septations containing complex fluid collections (Fig. 9). Tubular configurations are usually indicative of pyosalpinx. Difficulty in distinguishing tubo-ovarian from other pelvic abscesses can be difficult. Tubo-ovarian abscesses frequently cause anterior displacement of the broad ligament as the mesovarium is positioned more posteriorly, and this can assist in making the diagnosis [37].Fig. 9


Radiological appearances of gynaecological emergencies.

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

Pelvic inflammatory disease with pyosalpinx on CT. This patient presented to the accident and emergency department with abdominal pain and pyrexia. She had a raised white cell count and CRP. The clinicians suspected an intra-abdominal collection. a CT demonstrates bilateral adnexal complex fluid-filled and thick-walled cysts typical for tubo-ovarian abcess formation, a complication of pelvic inflammatory disease. b Coronal reformat of the CT demonstrates bilateral tubo-ovarian abcesses as well as distention of multiple bowel loops due to an associated ileus
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3369119&req=5

Fig9: Pelvic inflammatory disease with pyosalpinx on CT. This patient presented to the accident and emergency department with abdominal pain and pyrexia. She had a raised white cell count and CRP. The clinicians suspected an intra-abdominal collection. a CT demonstrates bilateral adnexal complex fluid-filled and thick-walled cysts typical for tubo-ovarian abcess formation, a complication of pelvic inflammatory disease. b Coronal reformat of the CT demonstrates bilateral tubo-ovarian abcesses as well as distention of multiple bowel loops due to an associated ileus
Mentions: In order to reduce exposure to radiation, CT is not usually employed as a first-line imaging investigation in cases of suspected PID. The CT appearances of PID are often non-specific with parapelvic fat stranding, a small volume of free fluid and thickened uterosacral ligaments. However, the development of tubo-ovarian abscesses results in thickened irregularly enhancing complex adnexal masses with thick walls and septations containing complex fluid collections (Fig. 9). Tubular configurations are usually indicative of pyosalpinx. Difficulty in distinguishing tubo-ovarian from other pelvic abscesses can be difficult. Tubo-ovarian abscesses frequently cause anterior displacement of the broad ligament as the mesovarium is positioned more posteriorly, and this can assist in making the diagnosis [37].Fig. 9

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