Pelvic pain is a common gynecological symptom that leads to a visit to the ER or a gynecologist. An acute pelvic pain is of sudden onset and is present for less than three months. It is reported in up to 24% of women and accounts for 2-10% of outpatient gynecological visits and 20% of laparoscopic surgery. Common causes of pelvic pain include conditions that affect the ovary, such as an ovarian cyst, fallopian tubes as in pelvic infection and uterus as in a rapidly growing fibroid. Ovarian cysts are common causes of acute pelvic pain in menstruating women. Ovarian cyst is a non-cancerous condition in the ovary, pain is caused by distension of the cyst or if there is bleeding/rupture of the cyst with leakage of fluid/blood into the abdominal cavity. These causes are readily identified on a pelvic ultrasound scan. An understanding of the normal physiological changes and the diseases affecting the female organs is necessary to make an accurate diagnosis of the cause of pelvic pain. Radiologists specialized in Gynecological imaging are critical in providing the treating gynecologist a guide as to the underlying cause allowing them to optimally treat a woman who present with pelvic pain. This expertise is critical in distinguishing infection from tumors, physiological conditions from tumors and infection, so the gynecologist is able to appropriately treat the patient and decide if surgical intervention is needed. A radiologist subspecialized in Gynecological imaging is also able to advise the gynecologist on any additional imaging needed to reach an accurate diagnosis.
A pelvic ultrasound in a young female with acute onset pelvic pain shows a ruptured ovarian cyst in the right ovary (arrowhead) causing accumulation of blood around the ovary (arrow)
A pelvic ultrasound performed for a patient with fever and pelvic pain shows an infected fallopian tube that is swollen and filled with infected fluid. She was then treated with antibiotics and recovered from pelvic infection.
Conditions such as an ectopic pregnancy (Pregnancy outside the uterus such as in the fallopian tube), twisting of the ovary (ovarian torsion) that cuts off its blood supply) can be life threatening and are surgical emergencies that need to be promptly treated. Preservation of a torsed ovary is only possible if diagnosis is made early on a pelvic ultrasound. This is particularly important in a young woman.
An ectopic pregnancy in an early stage (arrowhead). The timely and early diagnosis by endovaginal ultrasound was life saving for this patient.
A swollen ovary without blood flow in a young woman who was sent for a pelvic ultrasound to determine the cause of the acute onset pelvic pain. Endovaginal ultrasound readily diagnosed the condition that allowed the gynecological surgeon to surgically correct the condition and restore blood supply to the ovary.
Chronic (long lasting) pelvic pain can be debilitating and refers to pain that may be intermittent or constant lasting for longer than 3 months. A pelvic ultrasound is the test most frequently ordered in a female with a pelvic pain and often the only examination needed to determine the cause of the pelvic pain and allows the gynecologist to effectively treat the cause of the pelvic pain. A gynecological origin for the pain is the most frequent cause. When the gynecological organs show no abnormality, other imaging tests such as a CT scan may be needed and is particularly useful in identifying non gynecological causes of pain such as a kidney or ureteral stone, or gastrointestinal conditions such as diverticulitis or appendicitis (See below)
Ultrasound with Doppler shows a mass like abnormality next to the ovary in a woman with pelvic pain. An appendiceal abscess was diagnosed on ultrasound and patient was taken to surgery where appendicitis was confirmed (surgical specimen shown below)
