Pelvic pain in the middle of the night: use of MRI for evaluation of pediatric female pathology in the emergent setting

Acute pelvic pain in pediatric female patients is a common cause of emergency room visits. Imaging plays a crucial role in the clinical evaluation of these patients. Pelvic pain in female children can result from various pathologies. Ultrasound is the preferred first line imaging study; however, magnetic resonance imaging (MRI) is a helpful adjunct after hours, as it is available 24/7 in many institutions. Advantages of MRI include superior delineation of anatomy and higher tissue contrast resolution, particularly of the small pelvic structures. Given the lack of ionizing radiation, there is increasing use of MRI in children and adolescents, specifically in an emergent setting. In this pictorial review, we discuss pelvic MRI techniques and illustrate imaging findings of common etiologies of pelvic pain, emphasizing the advantages of MRI as an adjunct imaging modality.