Role of multidetector CT in the management of acute female pelvic disease

Abstract

The purpose of this study is to highlight the role of multidetector CT (MDCT) in emergency radiology as a useful tool in the diagnosis and management of acute female pelvic disease and to describe key radiologic signs to improve differential diagnosis. We restrospectively reviewed MDCT findings of acute pelvic disease and its mimics in women reporting to the emergency room at our institution from December 2006 to August 2008. We describe MDCT findings of gynecologic and obstetric disorders such as hemorrhagic ovarian cysts, ovarian torsion, pelvic inflammatory disease, ruptured ectopic pregnancy, intravascular leiomyomatosis, blunt maternal trauma, and postpartum and post-cesarean section complications. We also briefly review gastrointestinal tract entities that may mimic these conditions. Although ultrasound is the imaging modality of choice for the evaluation of female pelvic pain, the role of MDCT remains essential in the management of patients in which gynecologic exploration is not diagnostic or undone since it is not the initial suspicion.

Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and 18F-FDG PET/CT

“…The mass contains fluid collections and the density of the fluid within these cystic structures is usually greater than fluid in the urinary bladder, representing pyogenic or hemorrhagic material [12,13]. Fluid-filled tubular lesions with enhancing, thick walls are findings of pyosalpinx and are frequently seen adjacent to or in a portion of TOAs [14][15][16]. CT is generally not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination (except for fatty tissue and calcification) and the disadvantages of irradiation [17].…”

Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings

“…The postpartum uterus is enlarged to twice its normal pre-pregnancy dimension (average size is 9×12×14 cm) (9). After delivery, the uterus shows a progressive involution from the gravid to the nongravid status, mainly during the first three days postpartum; the uterus progressively returns to its normal size within 6-11 weeks (5,8).…”

“…However, the low transverse incision presents ill-defined margins on axial CT images because it is parallel to the CT imaging plane. Sagittal and oblique axial reformatted CT images provide a better imaging of myometrial discontinuity by using imaging planes perpendicular and parallel to the surgical plane (5,9). CT interpretation is often very difficult during the first days after CS, because normal early postsurgical changes and possible complications may have similar appearance (3).…”

“…The period of onset can vary from 2 to 10 days postpartum. It is usually unilateral (only 10%-14% of cases are bilateral), affecting commonly the right ovarian vein (up to 80%-90%), likely because it is usually larger than the left one, has multiple incompetent valves (1,4,7,9), and merges obliquely with the inferior vena cava. Moreover, the retrograde flow from the left renal vein to the ovarian vein during pregnancy and postpartum is thought to be protective (4).…”

“…Moreover, the retrograde flow from the left renal vein to the ovarian vein during pregnancy and postpartum is thought to be protective (4). The thrombus from the right ovarian vein can spread anywhere in the inferior vena cava or renal vein (1,9). A bland thrombus may be complicated by thrombophlebitis particularly in postpartum infection as endometritis.…”