Gynecologic Emergencies

  • Patrice Taourel
  • Fernanda Curros Doyon
  • Ingrid Millet
Part of the Medical Radiology book series (MEDRAD)


Acute pelvic pain is a routine situation in an emergency department. Ultrasonography is classically the first and sometimes the only necessary imaging tool. MRI is the preferred technique in young woman. However, in clinical practice CT is being performed more and more often as the first-line imaging in patients for whom the clinical hypotheses are often not good ones. Many gynaecologic disorders, including pelvic inflammatory disease, endometriosis, adnexal torsion, hemorrhage or rupture, leiomyoma complications, and pregnancy or postpartum complications, demonstrate suggestive CT findings. However, interpretation of these CT findings must take into account the age of the patient and the patient’s hormonal status.


Fallopian Tube Ectopic Pregnancy Pelvic Inflammatory Disease Uterine Leiomyoma Ovarian Torsion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW (2006) Radiology of gestational trophoblastic neoplasia. Clin Radiol 61:301–313PubMedCrossRefGoogle Scholar
  2. Augustin G, Majerovic M (2007) Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 131:4–12PubMedCrossRefGoogle Scholar
  3. Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801PubMedGoogle Scholar
  4. Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA (2003) CT of the acute abdomen: gynecologic etiologies. Abdom Imaging 28:416–432PubMedCrossRefGoogle Scholar
  5. Bennett GL, Slywotzky CM, Cantera M, Hecht EM (2010) Unusual manifestations and complications of endometriosis. Spectrum of imaging findings: pictorial review. AJR Am J Roentgenol 194:34–46CrossRefGoogle Scholar
  6. Borders RJ, Breiman RS, Yeh BM, Qayyum A, Coakley FV (2004) Computed tomography of corpus luteal cysts. J Comput Assist Tomogr 28:340–342PubMedCrossRefGoogle Scholar
  7. Bouguizane S, Bibi H, Farhat Y et al (2003) Les torsions des annexes de l’utérus. Aspects cliniques et thérapeutiques: à propos d’une série de 135 cas. J Gynecol Obstet Biol Reprod 32:535–540Google Scholar
  8. Cho HJ, Kim HK, Suh JH, Lee GJ, Shim JC, Kim YH (2008) Fitz-Hugh-Curtis syndrome: CT findings of three cases. Emerg Radiol 15:43–46PubMedCrossRefGoogle Scholar
  9. Delvigne A, Rozenberg S (2003) Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update 9:77–96PubMedCrossRefGoogle Scholar
  10. Eyvazzadeh AD, Levine D (2006) Imaging of pelvic pain in the first trimester of pregnancy. Radiol Clin North Am 44:863–877PubMedCrossRefGoogle Scholar
  11. Genevois A, Marouteau N, Lemercier E, Dacher JN, Thiebot J (2008) Imagerie de la douleur pelvienne aiguë. J Radiol 89:92–106PubMedCrossRefGoogle Scholar
  12. Ghang HG, Bhatt S, Dogra VS (2008) Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 28:1655–1668Google Scholar
  13. Ghossian MA, Buy JN, Sciot C, Jacob H, Hugol D, Vadrot D (1997) CT findings before and after adnexal torsion: rotation of a focal solid element of a cystic adjunctive sign in diagnosis. AJR Am J Roentgenol 169:1343–1346Google Scholar
  14. Green CL, Angtuaco TL, Shah HR, Parmley TH (1996) Gestational trophoblastic disease: a spectrum of radiologic diagnosis. Radiographics 16:1371–1384PubMedGoogle Scholar
  15. Gupta N, Dadhwal V, Misra R, Mittal S, Kiran S (2008) Atypical presentation of a leiomyoma as spontaneous massive haemoperitoneum. Eur J Obstet Gynecol Reprod Biol 138:114–124CrossRefGoogle Scholar
  16. Ha HK, Lee HJ, Kim H et al (1993) Abdominal actino-mucosis: CT findings in 10 patients. AJR Am J Roentgenol 161:791–794PubMedGoogle Scholar
  17. Hallatt JG, Steele GH Jr, Snyder M (1984) Ruptured corpus luteum with hemoperitoneum: a study of 173 surgical cases. Am J Obstet Gynecol 149:5–9PubMedGoogle Scholar
  18. Has R, Topuz S, Kalelioglu I, Tagrikulu D (2008) Imaging features of postpartum uterine rupture: a case report. Abdom Imaging 33:101–103PubMedCrossRefGoogle Scholar
  19. Hertzberg BS, Kliewer MA, Paulson EK (1999) Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis. Abdom Imaging 24:304–308PubMedCrossRefGoogle Scholar
  20. Hiller N, Appelbaum L, Simanovsky N, Lev-Sagi A, Aharoni D, Sella T (2007) CT features of adnexal torsion. AJR Am J Roentgenol 189:124–129PubMedCrossRefGoogle Scholar
  21. Jeong YY, Kang HK, Park JG, Ghoi HS (2003) CT features of uterine torsion. Eur Radiol 13:249–250CrossRefGoogle Scholar
  22. Kim IY, Lee BH (1997) Ovarian hyprestimulation syndrome: US and CT appearances. Clin Imaging 21:284–286PubMedCrossRefGoogle Scholar
  23. Kim SH, Kim SH, Yang DM, Kim KA (2004) Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 24:1575–1589PubMedCrossRefGoogle Scholar
  24. Kim JY, Kim Y, Jeong WK, Song SY, Cho OK (2009) Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID. Abdom Imaging 34:737–742PubMedCrossRefGoogle Scholar
  25. Lazarus E, Mayo-Smith W, Mainiero MB, Spencer PK (2007) CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 244:784–790PubMedCrossRefGoogle Scholar
  26. Lee JH, Park SB, Shin SH et al (2009) Value of intra-adnexal and extra-adnexal computed tomographic imaging features diagnosing torsion of adnexal tumor. J Comput Assist Tomogr 33:872–876PubMedCrossRefGoogle Scholar
  27. Lin EP, Bhatt S, Dogra VS (2008) Diagnostic clues to ectopic pregnancy. Radiographics 28:1661–1671PubMedCrossRefGoogle Scholar
  28. Lotterman S (2008) Massive hemoperitoneum resulting from spontaneous rupture of uterine leiomyoma. Am J Emerg Med 26:974e1–974e2CrossRefGoogle Scholar
  29. Lubner M, Menias C, Rucker C (2007) Blood in the belly: CT findings of hemoperitoneum. Radiographics 27:109–125PubMedCrossRefGoogle Scholar
  30. Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z (1990) Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril 53:76–80PubMedGoogle Scholar
  31. Matsumoto H, Ohta T, Nakahara K, Kojimahara T, Kurachi H (2007) Torsion of a nongravid uterus with a large ovarian cyst: usefulness of contrast MR image. Gynecol Obstet Invest 63:163–165PubMedCrossRefGoogle Scholar
  32. McCormack WM (1994) Pelvic inflammatory disease. N Engl J Med 330:115–119PubMedCrossRefGoogle Scholar
  33. McWilliams G, Hill MJ, Dietrich CS (2008) Gynecologic emergencies. Surg Clin N Am 88:265–283PubMedCrossRefGoogle Scholar
  34. Menias CO, Elsayes KM, Peterson CM et al (2007) CT of pregnancy-related complications. Emerg Radiol 13:299–306PubMedCrossRefGoogle Scholar
  35. Munsik R, Gillanders L (1981) A review of the syndrome of puerperal ovarian vein thrombophlebitis. Obstet Gynecol Surv 36:57–66CrossRefGoogle Scholar
  36. Namavar Jahromi B, Parsanezhad ME, Ghane-Shirazi R (2001) Female genital tuberculosis and infertility. Int J Gynaecol Obstet 75:269–272PubMedCrossRefGoogle Scholar
  37. Panghaal VS, Chernyak V, Patlas M, Rozenblit AM (2009) CT features of adnexal involvement in patients with diverticulitis. AJR Am J Roentgenol 192:963–966PubMedCrossRefGoogle Scholar
  38. Pellerito JS, Taylor KJ, Quedens-Case C et al (1992) Ectopic pregnancy: evaluation with endovaginal color flow imaging. Radiology 183:407–411PubMedGoogle Scholar
  39. Pham H, Lin EC (2007) Adnexal ring of ectopic pregnancy detected by contrast-enhanced CT. Abdom Imaging 32:56–58PubMedCrossRefGoogle Scholar
  40. Potter W, Chandrasekhar CA (2008) US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics 28:1645–1659PubMedCrossRefGoogle Scholar
  41. Rha SE, Byun JY, Jung SE et al (2002) CT and MR imaging features of adnexal torsion. Radiographics 22:283–294PubMedGoogle Scholar
  42. Romo LV, Clarke PD (1992) Fitz-Hugh-Curtis syndrome: pelvic inflammatory disease with an unusual CT presentation. J Comput Assist Tomogr 16:832–833PubMedCrossRefGoogle Scholar
  43. Rooholamini SA, Hansen GC, Kioumehr F et al (1993) Imaging of pregnancy related complications. Radiographics 13:753–770PubMedGoogle Scholar
  44. Roy C, Bierry G, El Ghali S, Buy X, Rossini A (2005) Acute torsion of uterine leiomyoma: CT features. Abdom Imaging 30:120–123PubMedCrossRefGoogle Scholar
  45. Sam JW, Jacobs JE, Birnbaum BA (2002) Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 22:1327–1334PubMedCrossRefGoogle Scholar
  46. Schraga ED, Kulkarni R, Blanda M (2008) Ovarian torsion. Accessed 14 Mar 2007
  47. Yitta S, Hecht ME, Sliwotzky CM, Bennett GL (2009) Added value of multiplanar reformation in the multidetector CT evaluation of the femal pelvis: a pictorial review. Radiographics 29:1987–2005PubMedCrossRefGoogle Scholar
  48. Zuckerman J, Levine D, McNicholas MJ et al (1997) Imaging of pelvic postpartum complications. AJR Am J Roentgenol 168:663–668PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Patrice Taourel
    • 1
  • Fernanda Curros Doyon
    • 1
  • Ingrid Millet
    • 1
  1. 1.Department of ImagingCHU Montpellier, Hospital LapeyronieMontpellier Cedex 5France

Personalised recommendations