Imaging of acute pelvic pain

Acute pelvic pain (APP) requires urgent medical evaluation and treatment. Differential diagnosis of APP is broad, including a variety of gynecologic and non-gynecologic/ urinary, gastrointestinal, vascular and other entities. Close anatomical and physiological relations of pelvic structures, together with similar clinical presentation of different disorders and overlapping of symptoms, especially in the emergency background, make the proper diagnosis of APP challenging. Imaging plays a crucial role in the fast and precise diagnosis of APP. Ultrasonography is the first-line imaging modality, often accompanied by CT, while MRI is utilized in specific cases, using short, tailored protocols. Recognizing the cause of APP in females is a challenging task, due to the wide spectrum of possible origin and overlap of their imaging features. Therefore, the radiologist has to be familiar with the possible causes of APP, and, relying on clinical presentation, together with laboratory findings, choose the best imaging strategy in order to establish a fast and accurate diagnosis.

Pelvic neuropathic pain (differential diagnosis)

Summary: Objective: General practitioners, surgeons, neurologists, urologists and gynecologists all encounter patients suffering from neurogenic pelvic pain. Correct management demands knowledge from all above mentioned specialties. The primary goal is to help patients suffering from chronic or acute pelvic pain coupled with functional disorders like dysuria, urgency, dyspareunia, mobility disorders orhypoesthesia. Neurogenic defects are not the most common etiology for either of listed symptoms. However, after exclusion of the more common ones and failure to respond to basic therapeutic methods such as physiotherapy or analgotheraphy doctors tend to mark the illness as idiopathic and incurable. The goal of this review is to show the most common nosological units and a robust diagnostic algorithm to describe the type and level of the damage. Methods: Review of literature using databases Pubmed, Science direct, Medline and sources of the international school of neuropelveology. Conclusion: Over a lifetime, one in seven women will suffer from chronic pelvic pain. Outside of the cases where a clear postoperative etiology is established, the time to make a correct dia gnosis is often long for the unspecific and varied symptomatology. Neuropelveological diagnostic algorithm is demonstrably efficient in shortening the time to diagnosis and more importantly to the treatment.

CLINCIAL PRESENTATION AND ULTRASONOGRAPHIC MARKERS OF PID

INTRODUCTION: Pelvic inammatory disease (PID) comprises a spectrum of inammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, Tubo-ovarian abscess, and pelvic peritonitis. The CDC has estimated that more than I Million women experience an episode of PID every year. Studies have reported prevalence ranging from 5.2% to 17.2% PID in various parts of India. Ultrasound:- TAS was initially used followed by use of TVS with Doppler in diagnosis of PID, although there are no large studies evaluating its sensitivity and or overall usefulness. Itis a frequentlyordered study in patients with classic symptoms of PID or who have unexplained, acute pelvic pain. MATERIAL AND METHODS:A retrospective analysis of medical records of patients with a complaint of lower abdominal pain was included in the study. Diagnosis of PID was made and patient was followed in the outdoor clinic. Pelvic examination was made. USG was done. According to symptoms and clinical examination for PID patients, the data was recorded. Medical record of 120 patients from 1 January 2020 to 31 May 2021 from a private clinic in Dist. Shivpuri were studied. RESULTS: In our study out of 120 cases, most of the patients 50.83% belonged to 26-30 years of age, a maximum number of patients were rural 83.33%. Most of the patients were educated below HSC 56.66%. Most of them 85% were married and most of them were multipara 56.66%. The most common presenting complaint was a pain in the abdomen (100%), followed by per vaginal discharge (65%), pain in the lower back (43.33%), abnormal uterine bleeding (40%), dysmenorrhoea (31.66%), dyspareunia (24.16), fever (17.5%) and others. On clinical examination abnormal PV discharge was present in 61.66% of cases, xed and retroverted uterus with or without thickend appendages were found in 55% of cases. Cervical motion tenderness was found in 78.33% of cases. Adnexal tenderness was found in 80% of cases but adnexal mass was found in 10.83% of cases. The most common nding on ultrasound scan was uid in the pouch of douglas 48.33%, followed by distal hydrosalphinx 28.33%, endometritis 18.33%, pyosalpinx 15%, TO Mass 13.33% and Pelvic collection in 10.83% of cases. CONCLUSION:The focus of this study was to identied socio-demographic characteristics of PID, to see the variety of presenting complaints and pelvic examination ndings and to correlate the clinical ndings with the USG ndings of PID. Much studies about the sensitivity & specicity of USG are not available, but this is denitely the most frequently ordered investigation in cases of PID. Transabdominal ndings of 'incomplete septa' 'cog wheel' 'beads on a strings' signs helps in distinguishing a dilated fallopian tube from other cystic adnexal masses To prevent long term sequelae PID should be the part of differential diagnosis in all patients aged 15-44 year with non specic abdominal pain.

Diagnostic accuracy of transabdominal ultrasound in respect to transvaginal ultrasound in diagnosing ectopic pregnancy in a tertiary care hospital of Kolkata taking histopathology as gold standard: a prospective study

Background: Ectopic pregnancy (EP) represents an important cause of acute pelvic pain in women of reproductive age. Initial evaluation consists of appropriate history and clinical examination followed by pelvic ultrasonography (US) and hormonal assays. Objective of the study was to measure diagnostic accuracy of TAS in respect to TVS in detecting ectopic pregnancy.Methods: This prospective cross sectional study was done for 1 year duration in Nilratan Sircar Medical College and Hospital, Kolkata. 50 patients with suspected ectopic pregnancy were transferred from Gynae emergency ward and trans-abdominal, transvaginal ultrasound were subsequently performed on each. The results were corroborated with histopathology reports..Results: Diagnostic parameters of TAS in respect to HPE:sensitivity 75.5, specificity-80,PPV-97.1, NPV-26.6 (all in percentages). Diagnostic parameters of TVS in respect to HPE:sensitivity 86.6, specificity-80, PPV-97.5, NPV-40 (all in percentages).Conclusions: Sonography by transvaginal route stood way ahead of trans abdominal scan in terms of all diagnostic parameters to correctly evaluate ectopic pregnancy.

ROLE OF MRI IN GYNECOLOGICAL EMERGENCIES

AIM: The aim of this study was to assess the emerging role of magnetic resonance imaging in the gynaecological emergencies. MATERIALS AND METHODS: Methods: Twenty nine non pregnant female patients with acute pelvic pain or bleeding per vagina who underwent MRI pelvis at our imaging department between November 2019 and August 2020 were reviewed. The final diagnosis was established by surgical findings in 16 cases, & biopsy in 1 respectively. The remaining 11 cases underwent follow-up MRI. Results: MRI was diagnostic in 28 (95.5%) out of 29 patients and non-diagnostic in 1 case. The commonest gynaecological emergency was ovarian cyst with complications. Imaging findings in 16 (55.2%) patients were correlated with surgery . The overall sensitivity and PPV of MRI in acute gynaecological conditions was 95.6% and 98.2%.

Unilateral absence of ovary and fallopian tube

A 19-year-old young woman was admitted to our Unit for irregular menstrual cycles within 40- to 60-day intervals for 7 months. She had no history of abdomino-pelvic surgery or acute pelvic pain. Pelvic magnetic resonance imaging revealed a right ovarian mass (Figure1A & B), measuring 6.0 cm X 5.1 cm X 5.0 cm. The patient underwent laparoscopy. At the laparoscopic examination, we evidenced a right ovarian teratoma about 6.0 cm X 6.0 cm and a small mesosalpinx cyst about 2.5 cm X 2.0 cm on the right fallopian tube (Figure 2A). On the left, neither fallopian tube nor ovary was detected (Figure 2B). We performed laparoscopic cystectomy and sutured residual ovarian tissues for hemostasis. Subsequent urinary ultrasonography demonstrated a normal urinary tract without any congenital anomaly. The pathological examination confirmed the diagnosis of mature teratoma and right mesosalpinx serous cyst. The patient was successfully discharged at the third day with no complications.

LA GROSSESSE HETEROTOPIQUE: A PROPOS DUN CASET REVUE DE LA LITTERATURE

Heterotopic pregnancy is defined by the simultaneous presence of an intrauterine pregnancy (GIU) and an ectopic pregnancy (GEU) in the same patient regardless of the location of the ectopic pregnancy. It is a pathological form of bi-ovular dizygotic twin pregnancy which implanted in the uterine cavity and the other in an ectopic situation. It is rare but exceptional, of ultrasound its diagnostic difficulties remain. This frequency has sharply increased in recent years due to the development of MAP techniques and the high frequency of upper genital infections. We report a case of a 37-year-old parturient who consulted for acute pelvic pain and bleeding in a context of amenorrhea and hemodynamic instability, a heterotopic pregnancy was diagnosed by ultrasound and an urgent mini laparotomy was performed. Through this case we want to retrospectively underline the great interest of the early diagnosis of heterotopic pregnancy in order to preserve the patients subsequent fertility as well as the GIU.