Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion

Acute pelvic pain: Diagnosis and management of ruptured hemorrhagic ovarian cyst

ABSTRACT

Acute pelvic pain in reproductive-aged persons who are assigned female at birth is associated with an extensive differential diagnosis, with possible causes ranging from the genitourinary or gastrointestinal to the musculoskeletal or neurovascular, in some cases even extending to psychological and dermatologic presentations. This article presents a case study that serves as an exemplar of the differential diagnosis of acute pelvic pain, culminating in diagnosis of the patient with a hemorrhagic ovarian cyst as well as a review of outpatient surveillance guidelines for adnexal masses. Management of this difficult-to-diagnose condition is reviewed, and special populations are considered.

Pathology and risk stratification-based evaluation of ovarian masses on MRI

Characterisation of an indeterminate ovarian mass is important as it guides management and clinical outcomes. Ultrasound is the first-line modality in the assessment of ovarian tumours. When ovarian masses are indeterminate on ultrasound, MRI provides excellent resolution in tissue characterisation and enhancement patterns. Ovarian masses can be categorised based on risk-scoring systems such as the American College of Radiology (ACR) MRI Ovarian-Adnexal Reporting and Data System (O-RADS). The imaging features of non-neoplastic, benign, borderline and malignant neoplastic ovarian lesions are discussed in this review with a focus on the pathology process accounting for the MRI appearance. Characteristic findings and clues in differentiating a benign lesion from a malignancy are presented in this review.

Adnexal masses: a compendium of established radiological signs

Adnexal masses are frequently encountered in general practice. Whether employing CT, US, or MRI, imaging plays a pivotal role in guiding appropriate treatment for patients with adnexal masses, potentially minimizing the need for surgery in benign cases and expediting the management of those with suspected malignancy. Accurately distinguishing benign from malignant adnexal masses can be challenging due to the confined pelvic space and the proximity of organs, making it difficult to determine their organ of origin or to distinguish tissue characteristics and imaging features. Radiologists have identified a myriad of classic adnexal imaging signs that are pathognomonic of certain diagnoses. Often named analogously to familiar objects, such as the "boba sign," familiarity with these signs can contribute to an accurate diagnosis, avoiding additional imaging tests. This pictorial review is a compendium of known radiological signs of adnexal pathologies, reiterating their role in making an accurate diagnosis, and guiding the next steps in management.

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications

Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient's body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.

Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis

Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis.

The Female Genital Tract on MDCT: A Pictorial Review of Normal Anatomy and Incidental Abnormalities

Purpose This article aims to review the pertinent anatomy and the incidental abnormalities involving the female genital tract on multidetector computed tomography (MDCT) through a pictorial review.

Methods The review is based on critical analysis of the existing literature as well as our experience in dealing with incidental lesions involving the female genital tract.

Results The lack of awareness regarding the normal appearances of the female pelvis on MDCT can puzzle the inexperienced radiologist and create management dilemmas for the treating clinician. It is important for radiologists to recognize normal appearances of the female genital tract on MDCT to prevent misinterpretation as pathology. The identification of incidentalomas of the female genital tract on CT can further guide whether additional workup is required or not. This pictorial review familiarizes radiologists with the normal appearances of the female genital tract on MDCT and a few common incidentalomas.

Conclusion It is imperative for a clinical radiologist to be familiar with the anatomy and common incidental lesions involving the female genital tract.

Identifying corpus luteum rupture as the culprit for haemoperitoneum

Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.