CT of the acute abdomen: gynecologic etiologies

Bennett, Genevieve L.; Harvey, W. B.; Slywotzky, Chrystia M.; Birnbaum, Bernard A.

doi:10.1007/s00261-002-0052-0

Cited by 18 publications

(14 citation statements)

References 51 publications

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“…However, this is nonspecific because other hemorrhagic lesions, such as hemorrhagic cysts, may also demonstrate this finding (8). Multiple lesions increase the specificity for the diagnosis of endometriomas because endometriomas are often multiple (20). …”

Section: Discussionmentioning

confidence: 99%

CT Imaging Findings of Ruptured Ovarian Endometriotic Cysts: Emphasis on the Differential Diagnosis with Ruptured Ovarian Functional Cysts

Lee

2011

Korean J Radiol

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ObjectiveThe purpose of this study is to assess the prevalence of abnormal CT findings in patients with surgically proven ruptured endometriotic cysts, as compared with those abnormal CT findings of ruptured ovarian functional cysts.Materials and MethodsThis study included 13 retrospectively identified patients with surgically confirmed ruptured ovarian endometriotic cysts and who had also undergone preoperative CT scanning during the previous seven years. As a comparative group, 25 cases of surgically confirmed ruptured ovarian functional cysts were included. We assessed the morphologic features of the cysts and the ancillary findings based on CT.ResultsFor the endometriotic cysts, the mean maximum cyst diameter was significantly larger than that of the functional cysts (70.1 mm versus 36.4 mm, respectively, p < 0.05). The endometriotic cysts frequently had a multilocular shape and a thicker cyst wall, as compared to that of functional cysts, and these differences were statistically significant. Among the ancillary findings, endometriotic cysts showed a significantly higher prevalence of loculated ascites, ascites confined to the pelvic cavity without extension to the upper abdomen, and peritoneal strandings and infiltrations (p < 0.05). Although 11 of the 25 cases of functional cysts showed active extravasation of contrast material at the ovarian bleeding site, only one of 13 cases of endometriotic cysts showed active extravasation.ConclusionThe diagnosis of ruptured endometriotic cyst should be suspected for a woman in whom CT reveals the presence of multilocular or bilateral ovarian cysts with a thick wall and loculated ascites confined to the pelvic cavity with pelvic fat infiltrations.

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Section: Discussionmentioning

confidence: 99%

CT Imaging Findings of Ruptured Ovarian Endometriotic Cysts: Emphasis on the Differential Diagnosis with Ruptured Ovarian Functional Cysts

Lee

2011

Korean J Radiol

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“…17 In advanced stages, there is usually extensive involvement of the adnexa with development of pyosalpinx and tuboovarian abscess (TOA) (Figs. 4,5). With a pyosalpinx, one sees a complex cystic mass with individual locules that seem to connect to one another as one scrolls through the images.…”

Section: Pelvic Inflammatory Diseasementioning

confidence: 96%

“…Computed tomographic findings in TOA include cystic adnexal structures with low-to-intermediate attenuation and thickened walls. 5 These findings may overlap with abscesses caused by other abdominopelvic acute inflammatory diseases, such as appendicitis or diverticulitis. One feature that distinguishes TOA from these other processes is the anterior displacement of the mesosalpinx, 18 which FIGURE 1.…”

Section: Pelvic Inflammatory Diseasementioning

confidence: 97%

“…Although ultrasound (US) remains the primary modality by which complaints specific to the pelvis are evaluated, in many instances, CT imaging occurs before sonographic evaluation. 4,5 Patel and Dubinsky 6 have articulated general principles that can guide imagers in determining when and when not to reimage the pelvis with ultrasound once CT has been performed. The purpose of this review is to illustrate a variety of gynecologic abnormalities that might be seen in the ED on CT.…”

mentioning

confidence: 99%

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Computed Tomographic and Magnetic Resonance Features of Gynecologic Abnormalities in Women Presenting With Acute or Chronic Abdominal Pain

Kalish

Patel

Gunn

et al. 2007

Ultrasound Quarterly

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Advances in technology and improved availability have led to increased use of computed tomography (CT) and magnetic resonance imaging (MRI) to evaluate women presenting to the emergency department or to their primary care provider with abdominal and/or pelvic pain. Computed tomographic examinations are often performed to evaluate the presence of appendicitis or renal stone disease. However, gynecologic abnormalities are frequently identified on these examinations. Although ultrasound remains the primary modality by which complaints specific to the pelvis are evaluated, in many instances, CT and MRI imaging occurs before sonographic evaluation.Historically, because of cost, radiation exposure, and relative ease of use, ultrasound examinations have preceded all other imaging modalities when evaluating pelvic disorders. However, as CT and MRI technology have improved, their use in diagnosing causes of pelvic pain has become equal to that of ultrasound. In some cases, primarily because of historic comfort with sonographic evaluation, gynecologic abnormalities originally diagnosed on CT or MRI may be immediately and unnecessarily reevaluated by ultrasound. For a woman in her reproductive years, the most common adnexal masses are physiological cysts, endometriomas, and cystic teratomas. Although lesions are often asymptomatic and incidentally detected, they can present with pain, and they increase the risk of ovarian torsion. Common causes of chronic pelvic pain in this population include leiomyomata and adenomyosis. In postmenopausal women, ovarian carcinoma, which often does not present clinically until a late stage, has to be included in the differential diagnosis of adnexal masses. If a gynecologic pathology is discovered on CT or MRI, an immediate follow-up ultrasound need not be pursued if the lesion can be characterized as benign, needing immediate surgical intervention, or a variant of normal anatomy. If, on the other hand, findings demonstrate a mass that either is uncharacteristic of a benign lesion, has an indeterminate risk for malignancy, or demonstrates suspicious characteristics for malignancy (such as enhancing mural nodules), further evaluation by serial ultrasound, biochemical marker, and/or CT or MRI is warranted. The purpose of this review is to present a series of commonly encountered gynecologic abnormalities with either CT or MR to make radiologists more familiar with gynecologic pathology on CT and MRI.

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“…26 Imaging, therefore, is usually reserved for patients who are nonresponsive to treatment with refractory pain or fever, to exclude an additional abnormality. 14 There are no classic sonographic findings of endometritis. The uterus may appear normal or may show nonspecific findings that overlap with retained products of conception including: a thickened heterogeneous endometrium and intrauterine fluid with or without internal echoes representing blood, retained products of conception, or gas.…”

Section: Endometritismentioning

confidence: 97%

Imaging of Acute Pelvic Pain

Vandermeer

Wong-You-Cheong²

2009

Clinical Obstetrics &Amp; Gynecology

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Determining the cause of acute pelvic pain in the female patient is often a clinical challenge. Diagnostic imaging can be invaluable in this situation. Ectopic pregnancy, pelvic inflammatory disease, and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain. Ovarian torsion and degenerating fibroids occur less frequently. Other causes to consider include endometriosis, and postpartum causes such as endometritis, or ovarian vein thrombosis. Finally, nongynecologic conditions may overlap in their presentation of acute pelvic pain and should also be considered. The most important of these is acute appendicitis.

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CT of the acute abdomen: gynecologic etiologies

Cited by 18 publications

References 51 publications

CT Imaging Findings of Ruptured Ovarian Endometriotic Cysts: Emphasis on the Differential Diagnosis with Ruptured Ovarian Functional Cysts

CT Imaging Findings of Ruptured Ovarian Endometriotic Cysts: Emphasis on the Differential Diagnosis with Ruptured Ovarian Functional Cysts

Computed Tomographic and Magnetic Resonance Features of Gynecologic Abnormalities in Women Presenting With Acute or Chronic Abdominal Pain

Imaging of Acute Pelvic Pain

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