Top

Insights into Imaging

Published in:

Open Access 01-06-2012 | Pictorial Review

Radiological appearances of gynaecological emergencies

Authors: Oran Roche, Nikita Chavan, Joseph Aquilina, Andrea Rockall

Published in: Insights into Imaging | Issue 3/2012

Abstract

Background

The role of various gynaecological imaging modalities is vital in aiding clinicians to diagnose acute gynaecological disease, and can help to direct medical and surgical treatment where appropriate. It is important to interpret the imaging findings in the context of the clinical signs and patient's pregnancy status.

Methods

Ultrasound and Doppler are readily available in the emergency department, and demonstrate features of haemorrhagic follicular cysts, ovarian cyst rupture, endometriotic cysts and pyosalpinx. Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone. Computed tomography (CT) is not routinely employed in diagnosing acute gynaecological complications. However due to similar symptoms and signs with gastrointestinal and urinary tract pathologies, it is frequently used as the initial imaging modality and recognition of features of gynaecological complications on CT is important.

Results

Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT.

Conclusion

MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion. In this article, we review the imaging appearances of gynaecological emergencies in non-pregnant patients.

Teaching points

• Ultrasonography is easily accessible and can identify life-threatening gynaecological complications.

• Tomography scanners and computed radiography are not routinely used but are important to recognise key features.

• MRI is used for the characterisation of acute gynaecological complications.

• Recognition of the overlap in symptoms between gastrointestinal and gynaecological conditions is essential.

Stenchever M (2001) Comprehensive gynaecology. 2nd edn. Mosby

Vandermeer FQ, Wong-You-Cheong JJ (2009) Imaging of acute pelvic pain. Clin Obstet Gynecol 52:2–20PubMedCrossRef

Ogawa Y, Fukuda T, Matsunaga N et al (1991) Computed tomographic features in ovarian bleeding. Nihon Igaku Hoshasen Gakkai Zasshi 51:394–399PubMed

Hertzberg BS, Kliewer MA, Bowie JD et al (1999) Adnexal ring sign and hemoperitoneum caused by hemorrhagic ovarian cyst: pitfall in the sonographic diagnosis of ectopic pregnancy. AJR Am J Roentgenol 173:1301–1302PubMedCrossRef

Kaakaji Y, Nghiem HV, Nodell C, Winter TC (2000) Sonography of obstetric and gynecologic emergencies: Part II, Gynecologic emergencies. AJR Am J Roentgenol 174:651–656PubMedCrossRef

Kaakaji Y, Nghiem HV, Nodell C, Winter TC (2000) Sonography of obstetric and gynecologic emergencies: Part I, Obstetric emergencies. AJR Am J Roentgenol 174:641–649PubMedCrossRef

Jeong YY, Outwater EK, Kang HK (2000) Imaging evaluation of ovarian masses. Radiographics 20:1445–1470PubMedCrossRef

Valentin L (2004) Use of morphology to characterize and manage common adnexal masses. Best Pract Res Clin Obstet Gynaecol 18:71–89PubMedCrossRef

Borders RJ, Breiman RS, Yeh BM, Qayyum A, Coakley FV (2004) Computed tomography of corpus luteal cysts. J Comput Assist Tomogr 28:340–342PubMedCrossRef

10.

Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801PubMedCrossRef

11.

Nishino M, Hayakawa K, Iwasaku K, Takasu K (2003) Magnetic resonance imaging findings in gynecologic emergencies. J Comput Assist Tomogr 27:564–570PubMedCrossRef

12.

Kataoka ML, Togashi K, Inoue T, Fujii S, Konishi J (1999) Evaluation of ectopic pregnancy by magnetic resonance imaging. Hum Reprod 14:2644–2650PubMedCrossRef

13.

Busard MP, Pieters-van den Bos IC, Mijatovic V, Van Kuijk C, Bleeker MC, van Waesberghe JH (2011) Evaluation of MR diffusion-weighted imaging in differentiating endometriosis infiltrating the bowel from colorectal carcinoma. Eur J Radiol Sept 9 [Epub ahead of print]

14.

Webb EM, Green GE, Scoutt LM (2004) Adnexal mass with pelvic pain. Radiol Clin North Am 42(2):329–348PubMedCrossRef

15.

Ding DC, Chen SS (2005) Conservative laparoscopic management of ovarian teratoma torsion in a young woman. J Chin Med Assoc 68:37–39PubMedCrossRef

16.

Kalish GM, Patel MD, Gunn ML, Dubinsky TJ (2007) Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. Ultrasound Q 23:167–175PubMedCrossRef

17.

Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JC (1994) Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 84:22–28PubMed

18.

Outwater EK, Siegelman ES, Hunt JL (2001) Ovarian teratomas: tumor types and imaging characteristics. Radiographics 21:475–490PubMedCrossRef

19.

Bis KG, Vrachliotis TG, Shetty AN, Maximovich A, Hricak H (1997) Pelvic endometriosis: MR imaging spectrum with laparoscopic correlation and diagnostic pitfalls. Radiographics 17:639–655PubMedCrossRef

20.

Porpora MG, Gomel V (1997) The role of laparoscopy in the management of pelvic pain in women of reproductive age. Fertil Steril 68:765–779PubMedCrossRef

21.

Coulier B, Malbecq S, Brinon PE, Ramboux A (2008) MDCT diagnosis of ruptured tubal pregnancy with massive hemoperitoneum. Emerg Radiol 15:179–182PubMedCrossRef

22.

Lee YR (2011) CT imaging findings of ruptured ovarian endometriotic cysts: emphasis on the differential diagnosis with ruptured ovarian functional cysts. Korean J Radiol 12:59–65PubMedPubMedCentralCrossRef

23.

Togashi K, Nishimura K, Kimura I (1991) Endometrial cysts: diagnosis with MR imaging. Radiology 180:73–78PubMedCrossRef

24.

Huchon C, Fauconnier A (2010) Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 150:8–12PubMedCrossRef

25.

Haskins T, Shull BL (1986) Adnexal torsion: a mind-twisting diagnosis. South Med J 79:576–577PubMedCrossRef

26.

Hibbard LT (1985) Adnexal torsion. Am J Obstet Gynecol 152:456–461PubMedCrossRef

27.

Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z (1991) Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet 173:363–366PubMed

28.

Chang HC, Bhatt S, Dogra VS (2008) Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 28:1355–1368PubMedCrossRef

29.

Mage G, Canis M, Menhes H, Pouly JL, Bruhat MA (1989) Laparoscopic management of adnexal torsion. A review of 35 cases. J Reprod Med 34:520–524PubMed

30.

Pena JE, Ufberg D, Cooney N, Denis AL (2000) Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 73:1047–1050PubMedCrossRef

31.

Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC (1998) Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med 17:83–89PubMed

32.

Rha SE, Byun JY et al (2002) CT and MR imaging features of adnexal torsion. Radiographics 22:283–294PubMedCrossRef

33.

Lee JH, Park SB, Shin SH (2009) Value of intra-adnexal and extra-adnexal computed tomographic imaging features diagnosing torsion of adnexal tumor. J Comput Assist Tomogr 33:872–876PubMedCrossRef

34.

Vercellini P, Maddalena S, de Giorgi O, Aimi G, Crosignani PG (1998) Abdominal myomectomy for infertility: a comprehensive review. Hum Reprod 13:873–879PubMedCrossRef

35.

Neuwirth RS (1995) Hysteroscopic submucous myomectomy. Obstet Gynecol Clin North Am 22:541–558PubMed

36.

Ueda H, Togashi K, Konishi I (1999) Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 19 Spec No: S131-145

37.

Dohke M, Watanabe Y, Okumura A (2000) Comprehensive MR imaging of acute gynecologic diseases. Radiographics 20:1551–1566PubMedCrossRef

38.

Wilde S, Scott-Barrett S (2009) Radiological appearances of uterine fibroids. Indian J Radiol Imaging 19:222–231PubMedCrossRef

39.

Kim JW, Lee CH, Kim KA, Park CM (2008) Spontaneous prolapse of pedunculated uterine submucosal leiomyoma: usefulness of broccoli sign on CT and MR imaging. Clin Imaging 32:233–235PubMedCrossRef

40.

Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J (1999) MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210:209–216PubMedCrossRef

41.

Sam JW, Jacobs JE, Birnbaum BA (2002) Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 22:1327–1334PubMedCrossRef

Title: Radiological appearances of gynaecological emergencies
Authors: Oran Roche
Nikita Chavan
Joseph Aquilina
Andrea Rockall
Publication date: 01-06-2012
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 3/2012
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-012-0157-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiological appearances of gynaecological emergencies

Abstract

Background

Methods

Results

Conclusion

Teaching points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Teaching points

Please log in to get access to this content

Other articles of this Issue 3/2012

Fetal MR in the evaluation of pulmonary and digestive system pathology

MR imaging of the reconstructed breast: What the radiologist needs to know

Multimodality Imaging Training Curriculum — Parts II and III

Paediatric multi-detector row chest CT: what you really need to know

A systematic approach for analysis, interpretation, and reporting of coronary CTA studies

Core curriculum for medical physicists in radiology. Recommendations from an EFOMP/ESR working group