ARRS 2022 Abstracts

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E1947. Imaging of the Acute Female Pelvis: A Resident’s On-Call Survival Guide to Challenging Cases
Authors
  1. Lauren Arsenault; George Washington School of Medicine and Health Sciences
  2. Margaret Houser; George Washington University Hospital
  3. Nadia Khati; George Washington University Hospital
Background
Acute pelvic pain is one of the most common female complaints in the emergency room. A nonspecific complaint, it encompasses a wide spectrum of pathologies of gynecologic, obstetric, and gastrointestinal etiologies. At our institution, sonographic evaluation of the pelvis using transabdominal (TA), and transvaginal (TV) scanning is typically the first imaging modality of choice. Many causes of acute female pelvic pain have classic imaging appearances on ultrasound (US), but accurate interpretation of more complex or less common pathologies can be challenging, especially for residents in training. Furthermore, additional cross-sectional imaging modalities such as MRI or at times CT can be useful problem-solving tools depending on the clinical scenarios.

Educational Goals / Teaching Points
We have found that residents can accurately interpret TVUS imaging findings for most common causes of acute pelvic pain; however, interpretation of more complex or rare pathologies can be a real challenge. This case-based educational exhibit showcases difficult pelvic US cases encountered by residents in our radiology department while on-call. Cases will include examples of complicated uterine, ovarian, and tubal causes of acute pelvic pain in both pregnant and non-pregnant females. Common pathologies that are easily identifiable will be outside the scope of this review.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
By taking the reader through a series of challenging cases that he/she may encounter while on-call in the middle of the night, this educational exhibit aims to illustrate sonographic findings of challenging gynecologic pathologies of uterine, ovarian, and tubal etiologies; review sonographic findings of obstetric causes of acute pelvic pain, including types of placental hemorrhages and offer an algorithm to differentiate them based on imaging characteristics; describe sonographic findings of post-partum pelvic pain and bleeding, including highlighting the differences between enhanced myometrial vascularity, arteriovenous malformations/fistulae, and retained products of conception; and present cases where additional CT or MRI are helpful in making the diagnosis.

Conclusion
This educational exhibit will give radiology residents exposure to real life challenging call cases. It is essential all residents understand the spectrum of imaging findings in various causes of acute pelvic pain to accurately interpret studies that will impact a patient’s immediate clinical management in the middle of the night.