Imagerie de la douleur pelvienne aiguë

[Acute Pelvic pain in women-gynecological causes]

BACKGROUND

Acute pelvic pain in women may be due to gynecological, gastrointestinal, and urinary tract disorders. Ectopic pregnancy (EP), pelvic inflammatory disease (PID), and ruptured ovarian cysts are the most common gynecological causes for acute pelvic pain and their diagnosis can be challenging.

METHODS

Patient history, clinical examination, and blood tests as well as patient age and potential pregnancy status help to establish the correct diagnosis. While sonography (US) remains the primary imaging modality of choice, computed tomography (CT) plays an important role in patients with indeterminate US evaluation and for treatment planning.

CONCLUSION

Diagnostic imaging is pivotal to differentiate potentially life- and fertility-threatening conditions from those that can be treated conservatively. Profound knowledge of the most common gynecological pathologies allows prompt and correct radiological diagnosis and assists in proper treatment planning.

[Pelvic mass in a young girl: think of hematocolpos]

L'hématocolpos est l'accumulation progressive du sang menstruel dans la cavité vaginale à la puberté. Il est souvent la conséquence d'une imperforation de l'hymen. Il se traduit sur le plan clinique par des douleurs pelviennes cycliques et une aménorrhée primaire. Plus rarement, il peut se révéler par une masse pelvienne. L’échographie est l'examen de choix pour le diagnostic de l'hématocolpos sur imperforation de l'hymen. L'imagerie par résonance magnétique (IRM) est l'examen d'imagerie de référence pour confirmer l'hématolcolpos et exclure d'autres malformations du canal de Muller ou des malformations urologiques associées. Nous rapportons un cas d'hématocolpos secondaire à une imperforation hyménéale diagnostiqué chez une jeune fille présentant une aménorrhée primaire et une masse pelvienne. Le diagnostic était posé par l’échographie et l'IRM et confirmé par l'intervention chirurgicale.

[Hygiene in endovaginal gynecologic and obstetrical ultrasound in 2008]

Hygiene of ultrasound probes is a hot topic in obstetric and gynecologic ultrasound. The issue concerns mainly the risk of contamination and the need for specific procedures to ensure a high degree of protection against infectious diseases, even if a disposable barrier cover is used. As there are no referenced quality criteria for these disposable probe covers, it is crucial to verify that they are CE marked. The use of condoms as probe covers is not recommended even though they present a lower rate of disruption compared to commercial probe covers. The global rate of probe cover perforation is of 1 to 9%. To date, there are no case reports of contamination by ultrasound examination, be it vaginal or abdominal. Nevertheless, every patient must be regarded as a potential source of infection. The French recommendations consider endovaginal ultrasound probes as semi-critical instruments and thus require intermediate-level disinfection. Because of the risk of disruption, American as well as Canadian and Australian recommendations insist on high-level disinfection of the probe. Every operator should follow reasonable hygiene rules and appropriate precautions should be taken in order to reassure the patients about the risks of contamination during any ultrasound examination.