ARRS 2022 Abstracts

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E1572. Adnexal Illusions: A Case-Based Review of Anatomy and Pathology in the Female Pelvis With Common and Uncommon Cases of Mistaken Identity
Authors
  1. Rahul Sachdev; Johns Hopkins University School of Medicine
  2. Oscar Covarrubias; Johns Hopkins University School of Medicine
  3. Erin Gomez; Johns Hopkins University School of Medicine
Background
Interpreting CT images of the female pelvis may be challenging, given complex regional anatomy, intraperitoneal location of the ovaries and fallopian tubes, and relatively low contrast resolution of CT compared with MRI. Given the nonspecific appearance of commonly encountered pathology in the pelvis (for example, ovarian cysts and neoplasia), normal variants may mimic true pathology and vice versa. For protocols designed to generate high-resolution volumes, an interpretation practice that routinely includes review of sagittal and coronal MPRs, careful attention to anatomy, and an understanding of subtle disease-specific characteristics are critical for accurate characterization of pelvic processes.

Educational Goals / Teaching Points
This exhibit aims to review normal pelvic anatomy across multiple imaging modalities with a focus on CT with 2D MPRs, highlighting strengths and limitations of each; present common and uncommon mimics of female pelvic anatomy and pathology with relevant pearls and pitfalls; and reinforce and review concepts with multiple case vignettes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
As a byproduct of complex anatomy and overlapping characteristics, normal anatomic structures in the female pelvis may mimic pathology and vice versa. In this exhibit, we will describe the clinical and imaging features of anatomic structures and disease entities that may be misinterpreted on pelvic CT, including pearls and pitfalls in identification of the ovaries, various manifestations of endometriosis, and typical and atypical appearances of uterine fibroids. We will review mimics of urgent pathology including ectopic pregnancy, ovarian torsion, and pelvic abscess, as well as urgent pathology mimicking benign pathology. Imaging findings in gynecologic malignancies and pelvic metastatic disease will also be reviewed. Information will be reinforced using multiple case vignettes.

Conclusion
Knowledge of normal anatomy and imaging features of commonly encountered disease processes in the female pelvis are key to accurate diagnosis. The practicing radiologist must be aware of pearls and pitfalls related to imaging of this anatomic region to avoid misinterpretation.