Abstracts

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E2150. Imaging of Gynecologic Oncology Emergencies
Authors
  1. Sadia Qamar; Sunnybrook Hospital, University of Toronto
  2. Tetyana Martin; British Columbia Cancer Agency; Vancouver General Hospital, University of British Columbia
  3. Savvas Nicolaou; Vancouver General Hospital, University of British Columbia
Background
Acute gynecologic oncologic emergencies with its primary tumoral, local or distant visceral, and vascular metastases related complications represent a unique subset of patients presenting to the emergency department (ED). An approximately 1.4 million gynecological emergency visits to the emergency department (ED) are recorded in the USA accounting for 24.3 visits per 1000 women of the reproductive age group (1). With an ever-increasing number of gynecologic oncologic emergencies, it is imperative for the emergency radiologist to have the knowledge and understanding of the wide spectrum of these presentations. Multidetector computed tomography (MDCT) with its advanced dual-energy (DE) applications plays a pivotal role in the identification of these gynecologic oncologic emergencies and help triage the patient to avoid associated morbidity and mortality.

Educational Goals / Teaching Points
1. Knowledge of primary tumoral, local/distant visceral, and vascular complications associated with gynecological oncologic emergencies. 2. Recognition of the imaging patterns in the gynecologic oncological emergent presentations. 3. Illustration of DE applications in selected ED cases to illustrate gynecologic oncologic complications. 4. Emphasis on the life-threatening gynecologic oncologic complications and their radiologic findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
List of commonly encountered and rare gynecological oncological emergencies 1. Incidental finding 2. 1st presentation of a primary gynecological emergency 3. Acute sudden progression of the symptoms in patients with established malignancy a) Carcinomatosis b) Intra-tumoral hemorrhage 4. Acute complication of a primary malignancy a) Tumor rupture b) Tumor torsion (Ovarian torsion) 5. Acute complication related to metastasis a) IJV thrombosis 6. Tumor related infiltrative / obstructive oncological emergencies a) Vascular i) Vascular invasion/infiltration/obstruction ii) Tumor thrombus/Bland thrombus b) Urinary i. Tumor infiltration ii. Obstructive hydronephrosis c) Bowel i. Obstruction ii. Ischemia iii. Perforation 7. Acute oncological treatment related emergencies i. Anticoagulation, biopsy or chemoembolization ii. Radiation complications 8. Tumor related sepsis/infection/inflammation

Conclusion
Gynecological oncologic emergencies require prompt identification and triage in the ED to avoid the associated high morbidity and mortality. MDCT with its unique DE applications has a substantial role in the identification of the primary tumoral, local/distant visceral, and vascular complications associated with these gynecologic oncological emergencies.