Utility of pelvic ultrasound following negative abdominal and pelvic CT in the emergency room

Gao, Yuanjing; Lee, Karen; Camacho, Marc A.

doi:10.1016/j.crad.2013.05.101

Cited by 16 publications

(21 citation statements)

References 14 publications

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“…As with abdominal CT and ultrasound, the recommendation for an initial pelvic ultrasound when evaluating female pelvic pain also stems from the reduced cost, absence of radiation exposure, and superior anatomic visualization of the pelvic organs when compared with pelvic CT. 2,13 However, as with the results of studies investigating the use of abdominal ultrasound after negative CT, a study of pelvic ultrasound after a negative CT revealed that only 4/126 (3.2%) follow-up ultrasounds had an abnormal finding not identified on CT. 13 Pelvic ultrasound found four endometrial abnormalities that did not alter acute management. 13 Notably, in 58% of the cases, the indication for ordering the subsequent ultrasound was "rule out ovarian torsion." However, CT almost always finds a morphologically abnormal ovary in the case of torsion.…”

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 92%

“…However, as with the results of studies investigating the use of abdominal ultrasound after negative CT, a study of pelvic ultrasound after a negative CT revealed that only 4/126 (3.2%) follow‐up ultrasounds had an abnormal finding not identified on CT 13 . Pelvic ultrasound found four endometrial abnormalities that did not alter acute management 13 . Notably, in 58% of the cases, the indication for ordering the subsequent ultrasound was “rule out ovarian torsion.” However, CT almost always finds a morphologically abnormal ovary in the case of torsion 6 .…”

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 98%

“…As with abdominal CT and ultrasound, the recommendation for an initial pelvic ultrasound when evaluating female pelvic pain also stems from the reduced cost, absence of radiation exposure, and superior anatomic visualization of the pelvic organs when compared with pelvic CT 2,13 . However, as with the results of studies investigating the use of abdominal ultrasound after negative CT, a study of pelvic ultrasound after a negative CT revealed that only 4/126 (3.2%) follow‐up ultrasounds had an abnormal finding not identified on CT 13 . Pelvic ultrasound found four endometrial abnormalities that did not alter acute management 13 .…”

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 99%

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Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Cunningham

Wachtel

Shaffie

et al. 2021

Journal of Hospital Medicine

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Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOA 70-year-old woman presented to the emergency department (ED) with diffuse abdominal pain, nausea, and vomiting with normal liver function tests and lipase. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed no acute intraabdominal pathology except for an incidentally noted, mildly enlarged but nondistended gallbladder without evident cholelithiasis, pericholecystic fluid, or gallbladder wall edema. The hospitalist orders an abdominal ultrasound to evaluate for acute biliary pathology potentially missed by CT.

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Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 92%

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 98%

“…As with abdominal CT and ultrasound, the recommendation for an initial pelvic ultrasound when evaluating female pelvic pain also stems from the reduced cost, absence of radiation exposure, and superior anatomic visualization of the pelvic organs when compared with pelvic CT 2,13 . However, as with the results of studies investigating the use of abdominal ultrasound after negative CT, a study of pelvic ultrasound after a negative CT revealed that only 4/126 (3.2%) follow‐up ultrasounds had an abnormal finding not identified on CT 13 . Pelvic ultrasound found four endometrial abnormalities that did not alter acute management 13 .…”

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 99%

See 1 more Smart Citation

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Cunningham

Wachtel

Shaffie

et al. 2021

Journal of Hospital Medicine

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show abstract

“…Ultrasound is the initial imaging modality of choice for evaluation of lower abdominal or pelvic pain in females. 2,4 However, ultrasound is neither 100% sensitive nor specific for diagnosing adnexal torsion. 3,5 MRI is used especially as a problem-solving tool in sonographically inconclusive cases.…”

Section: Epidemiology Predisposing Conditions and Clinical Featuresmentioning

confidence: 99%

“…Very often, it may be the first imaging modality available to patients presenting with an unexpected diagnosis of ovarian torsion. 4 CT is also used as an adjunct if the ultrasound findings are inconclusive or if the lesion is not well depicted sonographically. 1 CT features of ovarian torsion include an enlarged ovary with or without an underlying mass or containing small peripheral hypoattenuating cystic structures around an oedematous ovarian stroma.…”

Section: Epidemiology Predisposing Conditions and Clinical Featuresmentioning

confidence: 99%

CT features in surgically proven cases of ovarian torsion—a pictorial review

Dhanda

Quek

Ting

et al. 2017

The British Journal of Radiology

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Ovarian torsion is a surgical emergency characterized by a partial or complete rotation of the ovarian vascular pedicle, causing obstruction to venous outflow followed by arterial inflow. Clinically, ovarian torsion frequently mimics other causes of acute pelvic pain such as appendicitis, diverticulitis, renal colic etc. Ultrasonography is the first-line imaging modality of choice for evaluation of ovarian torsion. MRI is useful as a problem-solving tool in patients with equivocal or non-diagnostic ultrasonography studies. CT is ordinarily not utilized in a young female with suspected ovarian torsion due to the radiation dose. However, the significant expansion in use of CT imaging in emergency departments for female patients presenting with acute abdominal pain has increased the likelihood that ovarian torsion may be first seen on CT. In addition, a non-specific clinical presentation may lead to an initial imaging with CT rather than ultrasonography. Ultrasound features of the ovarian torsion are well known and sufficiently described across literature as compared with the CT scan findings. In view of the increasing usage of CT as the modality of choice in emergency settings, it is imperative for the radiologist to familiarize with the CT features of ovarian torsion. An early correct diagnosis by the radiologist in clinically unsuspected cases, facilitating a prompt surgery to restore the ovarian blood flow can prevent permanent irreversible damage. There is limited published data available on the CT features of ovarian torsion. This pictorial essay illustrates CT findings with histological correlation of surgically proven ovarian torsion in our institution. These patients were primarily investigated with CT scan for acute pelvic pain ascribed to non-gynaecological causes such as bowel or urinary tract lesions.

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Acute, Nonspecific, Nontraumatic Abdominal Pain

Silva

Bellolio

2023

Evidence‐Based Emergency Care

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Utility of pelvic ultrasound following negative abdominal and pelvic CT in the emergency room

Cited by 16 publications

References 14 publications

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

CT features in surgically proven cases of ovarian torsion—a pictorial review

Acute, Nonspecific, Nontraumatic Abdominal Pain

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