E5181. Pelvic Ultrasound for Nonobstetric Pelvic Pain: Anatomy and Do-Not-Miss Diagnoses for the Trainee On Call
Authors
Nikhil Gupta;
Tufts Medical Center
Rita Lahoud;
Tufts Medical Center
Megan Kenway;
Tufts Medical Center
Yilun Zhang;
Tufts Medical Center
Terri Williams-Weekes;
Tufts Medical Center
Background
Ultrasonography is commonly requested when female patients present with acute pelvic pain in the emergency department and is frequently encountered by radiology trainees while on call. Although clinical evaluation and laboratory testing may help guide the diagnosis, ultrasound is a first-line modality for this indication and often plays an essential role in advancing care. The causes of acute pelvic pain are numerous and can be divided into obstetric and nonobstetric etiologies, the latter of which is the subject of this discussion. As the differential diagnosis is broad and may require urgent interventions, it is imperative that trainees develop an adequate understanding and approach to this situation.
Educational Goals / Teaching Points
1. Review the range of normal pelvic anatomy on transabdominal and transvaginal ultrasound with still and cine images. 2. Discuss common gynecologic causes of acute pelvic pain in nongravid patients with negative pregnancy test. 3. Understand the major pitfalls for each cause.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pelvic ultrasound is first line in the evaluation of acute pelvic pain the emergency department. Appropriate evaluation is underscored by an understanding of the appearance of a range of normal female anatomy on ultrasound, taking into account factors such as age and menstrual status. As the causes of acute pelvic pain in females are broad, this discussion is limited to gynecologic causes of acute pelvic pain in nonobstetric patients. There will be a trainee-oriented succinct, image-rich, and clinically relevant discussion of the ultrasound characteristics of each commonly encountered cause. Findings that aid in distinguishing between etiologies such as size, morphology, echogenicity, doppler signal will be highlighted along with complications to be aware of. Each diagnosis will state common pitfalls and methods to overcome them.
Conclusion
Radiology trainees frequently interpret ultrasound for acute pelvic pain in nonobstetric female patients while on call. Imaging often directs next steps in care, and as there is a broad differential diagnosis with substantial clinical implications such as surgical intervention, this situation can be challenging for trainees. Knowledge of the appearance of pelvic anatomy on ultrasound, sonographic characteristics of each condition, and frequently encountered pitfalls will aid trainees in the interpretation of patients with acute pelvic pain.
