RETURN TO ABSTRACT LISTING


Background
Pelvic pain is a common complaint in both the outpatient and emergency setting, with one study estimating that 1 in 7 women will experience acute or chronic pelvic pain in their lifetime. The difficulty with this presentation arises from a combination of nonspecific signs and symptoms, broad differential, and potentially devastating consequences. To compound this further, physical exam is often insensitive and/or nonspecific for key diagnoses. Even hallmark findings such as abnormal uterine bleeding, cervical motion tenderness or adnexal mass are common across an array of conditions. Ultrasound (US) is widely accepted as the initial imaging of choice for this presentation due to its high diagnostic sensitivity, safety profile, and cost-effectiveness. Real-time evaluation of anatomy and vascular flow are tremendously helpful in differentiating benign findings from more emergent cases that require prompt management. However, it is not perfect. Operator dependency and a high false negative rate for conditions such as torsion are some of the limitations of this technique. In-depth knowledge of key US findings is crucial for radiologists to understand the limitations of the examination in the setting of pelvic emergencies. The purpose of this exhibit is to review the key US findings of common and some atypical etiologies of pelvic pain in a case-based format. This material will assist the reader in their distinction of benign versus emergent diagnoses with a quantitative metric of diagnostic confidence.

Educational Goals / Teaching Points
This exhibit will lay out a case-based review of US findings of various disease processes with a focus on cases encountered in the emergency setting including adnexal torsion, pelvic inflammatory disease (PID), ectopic pregnancy (EP), ruptured cysts, endometriomas, torsion, fibroids, and anomalous anatomy. Each case will provide a presenting patient history, ultrasound imaging and a cross sectional correlation when available. We will review the key sonographic findings of each diagnosis, the sensitivity and/or specificity of key findings and the limitations of ultrasound.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomic and pathophysiologic issues include diseases of the uterus, salpinges, and adnexa. The focus is on pelvic ultrasound with a discussion of key findings. The main technique utilized is transvaginal (TV) ultrasound as it provides a higher resolution in-depth examination of the pelvic structures, although it is not always tolerated. Transabdominal (TA) ultrasound is less invasive and provides a wide anatomic overview. These techniques are often used in tandem as a combination can increase the diagnostic certainty in specific conditions.

Conclusion
US is the most appropriate initial imaging modality for acute pelvic pain due to its safety and efficiency. Pelvic US can quickly characterize various disease processes in an emergency setting where a timely diagnosis leads to improved patient outcomes.