Advertisement

Acute and Chronic Pelvic Pain Disorders

  • Amy DavisEmail author
  • Andrea Rockall
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

This chapter will cover common gynecological and non-gynecological causes of acute and chronic pelvic pain, with particular focus on the differential diagnosis and imaging characteristics. The relative frequency of each diagnosis by MRI or CT is listed in Table 1. Gynecologic disorders highly associated with chronic pelvic pain such as endometriosis, uterine leiomyomas, and adenomyosis are discussed in previous chapters in this book.

References

  1. Akhan SE, Dogan Y, Akhan S, Iyibozkurt AC, Topuz S, Yalcin O (2008) Pelvic actinomycosis mimicking ovarian malignancy: three cases. Eur J Gynaecol Oncol 29(3):294–297PubMedGoogle Scholar
  2. Almeida AT, Melao L, Viamonte B, Cunha R, Pereira JM (2009) Epiploic appendagitis: an entity frequently unknown to clinicians—diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol 193(5):1243–1251PubMedGoogle Scholar
  3. Andersson RE, Hugander A, Thulin AJ (1992) Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate. Eur J Surg 158(1):37–41PubMedGoogle Scholar
  4. Arnoldussen CW (2015). Diagnostic imaging of pelvic congestive syndrome. In: de Wolf MA (ed), Phlebology. pp 67–72Google Scholar
  5. Asciutto G, Mumme A, Marpe B, Koster O, Asciutto KC, Geier B (2008) MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg 36(4):491–496PubMedGoogle Scholar
  6. Assal A, Kaner JD, Danda N, Cohen HW, Billett HH (2017) Risk factors and prognosis of ovarian vein thrombosis. Blood Coagul Fibrinolysis. DOI: 10.1097/MBC.0000000000000623Google Scholar
  7. Atay Y, Altintas A, Tuncer I, Cennet A (2005) Ovarian actinomycosis mimicking malignancy. Eur J Gynaecol Oncol 26(6):663–664PubMedGoogle Scholar
  8. Bazot M, Detchev R, Cortez A, Uzan S, Darai E (2003) Massive ovarian edema revealing gastric carcinoma: a case report. Gynecol Oncol 91(3):648–650PubMedGoogle Scholar
  9. Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22(4):785–801PubMedGoogle Scholar
  10. Beranger-Gibert S, Sakly H, Ballester M, Rockall A, Bornes M, Bazot M et al (2016) Diagnostic value of MR imaging in the diagnosis of adnexal torsion. Radiology 279(2):461–470PubMedGoogle Scholar
  11. Berna JD, Garcia-Medina V, Guirao J, Garcia-Medina J (1996) Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging 21(1):62–64PubMedGoogle Scholar
  12. Blum A, Bui P, Boccaccini H, Bresler L, Claudon M, Boissel P et al (1995) Imaging of severe forms of hematoma in the rectus abdominis under anticoagulants. J Radiol 76(5):267–273PubMedGoogle Scholar
  13. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod (Oxford, England) 17(12):3224–3230Google Scholar
  14. Champaneria R, Shah L, Moss J, Gupta JK, Birch J, Middleton LJ et al (2016) The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess (Winchester, England) 20(5):1–108Google Scholar
  15. Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD 3rd (1999) Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 210(2):429–435PubMedGoogle Scholar
  16. Cobben LP, Groot I, Blickman JG, Puylaert JB (2003) Right colonic diverticulitis: MR appearance. Abdom Imaging 28(6):794–798PubMedGoogle Scholar
  17. Currarino G, Rutledge JC (1989) Ovarian torsion and amputation resulting in partially calcified, pedunculated cystic mass. Pediatr Radiol 19(6–7):395–399PubMedGoogle Scholar
  18. Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN (1991) Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 46(7):415–427PubMedGoogle Scholar
  19. Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338(21):1521–1526PubMedGoogle Scholar
  20. Filhastre M, Dechaud H, Lesnik A, Taourel P (2005) Interstitial pregnancy: role of MRI. Eur Radiol 15(1):93–95PubMedGoogle Scholar
  21. Fishman EK, Wolf EJ, Jones B, Bayless TM, Siegelman SS (1987) CT evaluation of Crohn’s disease: effect on patient management. AJR Am J Roentgenol 148(3):537–540PubMedGoogle Scholar
  22. Forstner R, Thomassin-Naggara I, Cunha TM, Kinkel K, Masselli G, Kubik-Huch R et al (2017) ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol 27(6):2248–2257PubMedPubMedCentralGoogle Scholar
  23. Fukuda T, Sakamoto I, Kohzaki S, Uetani M, Mori M, Fujimoto T et al (1996) Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 21(1):58–61PubMedGoogle Scholar
  24. Furukawa A, Saotome T, Yamasaki M, Maeda K, Nitta N, Takahashi M et al (2004) Cross-sectional imaging in Crohn disease. Radiographics 24(3):689–702PubMedGoogle Scholar
  25. Ghiatas AA (2004) The spectrum of pelvic inflammatory disease. Eur Radiol 14(Suppl 3):E184–E192PubMedGoogle Scholar
  26. Ghossain MA, Buy JN, Bazot M, Haddad S, Guinet C, Malbec L et al (1994) CT in adnexal torsion with emphasis on tubal findings: correlation with US. J Comput Assist Tomogr 18(4):619–625PubMedGoogle Scholar
  27. Gore RM, Balthazar EJ, Ghahremani GG, Miller FH (1996) CT features of ulcerative colitis and Crohn’s disease. AJR Am J Roentgenol 167(1):3–15PubMedGoogle Scholar
  28. Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P (2002) MR enteroclysis: technical considerations and clinical applications. Eur Radiol 12(11):2651–2658PubMedGoogle Scholar
  29. Graif M, Itzchak Y (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol 150(3):647–649PubMedGoogle Scholar
  30. Gulati MS, Paul SB, Batra A, Sarma D, Dadhwal V, Nath J (2000) Uterine arteriovenous malformations: the role of intravenous ‘dual-phase’ CT angiography. Clin Imaging 24(1):10–14PubMedGoogle Scholar
  31. Ha HK, Lee HJ, Kim H, Ro HJ, Park YH, Cha SJ et al (1993) Abdominal actinomycosis: CT findings in 10 patients. AJR Am J Roentgenol 161(4):791–794PubMedGoogle Scholar
  32. Haque TL, Togashi K, Kobayashi H, Fujii S, Konishi J (2000) Adnexal torsion: MR imaging findings of viable ovary. Eur Radiol 10(12):1954–1957PubMedGoogle Scholar
  33. Hildyard CA, Gallacher NJ, Macklin PS (2013) Abdominopelvic actinomycosis mimicking disseminated peritoneal carcinomatosis. BMJ Case Rep 2013 DOI: 10.1136/bcr-2013-201128Google Scholar
  34. Horrow MM, White DS, Horrow JC (2003) Differentiation of perforated from nonperforated appendicitis at CT. Radiology 227(1):46–51PubMedGoogle Scholar
  35. Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20(2):399–418PubMedGoogle Scholar
  36. Kang JY, Melville D, Maxwell JD (2004) Epidemiology and management of diverticular disease of the colon. Drugs Aging 21(4):211–228PubMedGoogle Scholar
  37. Kataoka ML, Togashi K, Kobayashi H, Inoue T, Fujii S, Konishi J (1999) Evaluation of ectopic pregnancy by magnetic resonance imaging. Hum Reprod (Oxford, England) 14(10):2644–2650Google Scholar
  38. Kawakami S, Togashi K, Kimura I, Nakano Y, Koshiyama M, Takakura K et al (1993) Primary malignant tumor of the fallopian tube: appearance at CT and MR imaging. Radiology 186(2):503–508PubMedGoogle Scholar
  39. Kim SH, Kim SH, Yang DM, Kim KA (2004) Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 24(6):1575–1589PubMedGoogle Scholar
  40. Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J (1994) Ovarian torsion: CT and MR imaging appearances. Radiology 190(2):337–341PubMedGoogle Scholar
  41. Koonings PP, Grimes DA (1989) Adnexal torsion in postmenopausal women. Obstet Gynecol 73(1):11–12PubMedGoogle Scholar
  42. Krasevic M, Haller H, Rupcic S, Behrem S (2004) Massive edema of the ovary: a report of two cases due to lymphatic permeation by metastatic carcinoma from the uterine cervix. Gynecol Oncol 93(2):564–567PubMedGoogle Scholar
  43. Kubik-Huch RA, Hebisch G, Huch R, Hilfiker P, Debatin JF, Krestin GP (1999) Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis. Abdom Imaging 24(1):85–91PubMedGoogle Scholar
  44. Kuligowska E, Deeds L 3rd, Lu K 3rd (2005) Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics 25(1):3–20PubMedGoogle Scholar
  45. Labs JD, Sarr MG, Fishman EK, Siegelman SS, Cameron JL (1988) Complications of acute diverticulitis of the colon: improved early diagnosis with computerized tomography. Am J Surg 155(2):331–336PubMedGoogle Scholar
  46. Laghi A, Borrelli O, Paolantonio P, Dito L, Buena de Mesquita M, Falconieri P et al (2003) Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 52(3):393–397PubMedPubMedCentralGoogle Scholar
  47. Lee AR, Kim KH, Lee BH, Chin SY (1993) Massive edema of the ovary: imaging findings. AJR Am J Roentgenol 161(2):343–344PubMedGoogle Scholar
  48. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC (1998) Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med 17(2):83–89PubMedGoogle Scholar
  49. Lopez AJ (2015) Female pelvic vein embolization: indications, techniques, and outcomes. Cardivasc Intervent Radiol 38(4):806–820Google Scholar
  50. Machairiotis N, Stylianaki A, Kouroutou P, Sarli P, Alexiou NK, Efthymiou E et al (2016) Massive ovarian oedema: a misleading clinical entity. Diagn Pathol 11:18PubMedPubMedCentralGoogle Scholar
  51. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF (1996) Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 87(3):321–327PubMedGoogle Scholar
  52. Moribata Y, Kido A, Yamaoka T, Mikami Y, Himoto Y, Kataoka M et al (2015) MR imaging findings of ovarian torsion correlate with pathological hemorrhagic infarction. J Obstet Gynaecol Res 41(9):1433–1439PubMedGoogle Scholar
  53. Nishino M, Hayakawa K, Kawamata K, Iwasaku K, Takasu K (2002) MRI of early unruptured ectopic pregnancy: detection of gestational sac. J Comput Assist Tomogr 26(1):134–137PubMedGoogle Scholar
  54. Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21(2):156–165PubMedGoogle Scholar
  55. Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M (2017) Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging 8(1):19–27PubMedGoogle Scholar
  56. Oto A, Ernst RD, Shah R, Koroglu M, Chaljub G, Gei AF et al (2005) Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging—initial experience. Radiology 234(2):445–451PubMedGoogle Scholar
  57. Park SJ, Lim JW, Ko YT, Lee DH, Yoon Y, Oh JH et al (2004) Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol 182(3):683–688PubMedGoogle Scholar
  58. Paulson EK, Kalady MF, Pappas TN (2003) Clinical practice. Suspected appendicitis. N Engl J Med 348(3):236–242PubMedGoogle Scholar
  59. Pereira JM, Sirlin CB, Pinto PS, Jeffrey RB, Stella DL, Casola G (2004) Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics 24(3):703–715PubMedGoogle Scholar
  60. Pereira JM, Sirlin CB, Pinto PS, Casola G (2005) CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls. Radiographics 25(1):69–85PubMedGoogle Scholar
  61. Petkovska I, Duke E, Martin DR, Irani Z, Geffre CP, Cragun JM et al (2016) MRI of ovarian torsion: correlation of imaging features with the presence of perifollicular hemorrhage and ovarian viability. Eur J Radiol 85(11):2064–2071PubMedGoogle Scholar
  62. Philpotts LE, Heiken JP, Westcott MA, Gore RM (1994) Colitis: use of CT findings in differential diagnosis. Radiology 190(2):445–449PubMedGoogle Scholar
  63. Pickhardt PJ, Bhalla S (2005) Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics 25(3):719–730PubMedGoogle Scholar
  64. Praveen R, Pallavi V, Rajashekar K, Usha A, Umadevi K, Bafna U (2013) A clinical update on massive ovarian oedema—a pseudotumour? Ecancermedicalscience 7:318PubMedPubMedCentralGoogle Scholar
  65. Protopapas AG, Diakomanolis ES, Milingos SD, Rodolakis AJ, Markaki SN, Vlachos GD et al (2004) Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol 114(2):203–209PubMedGoogle Scholar
  66. Quane LK, Kidney DD, Cohen AJ (1998) Unusual causes of ovarian vein thrombosis as revealed by CT and sonography. AJR Am J Roentgenol 171(2):487–490PubMedGoogle Scholar
  67. Rao PM, Novelline RA (1999) Case 6: primary epiploic appendagitis. Radiology 210(1):145–148PubMedGoogle Scholar
  68. Rao PM, Rhea JT, Novelline RA (1997) Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21(5):686–692PubMedGoogle Scholar
  69. Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M (2016) Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics 36(5):1579–1596PubMedGoogle Scholar
  70. Rha SE, Byun JY, Jung SE, Jung JI, Choi BG, Kim BS et al (2002) CT and MR imaging features of adnexal torsion. Radiographics 22(2):283–294PubMedGoogle Scholar
  71. Riley GM, Babcook C, Jain K (1996) Ruptured malignant ovarian tumor mimicking ruptured ectopic pregnancy. J Ultrasound Med 15(12):871–873PubMedGoogle Scholar
  72. Roche O, Chavan N, Aquilina J, Rockall A (2012) Radiological appearances of gynaecological emergencies. Insights Imaging 3(3):265–275PubMedPubMedCentralGoogle Scholar
  73. Rollandi GA, Curone PF, Biscaldi E, Nardi F, Bonifacino E, Conzi R et al (1999) Spiral CT of the abdomen after distention of small bowel loops with transparent enema in patients with Crohn’s disease. Abdom Imaging 24(6):544–549PubMedGoogle Scholar
  74. Rottenstreich A (2016) Pregnancy and non-pregnancy related ovarian vein thrombosis: clinical course and outcome. Thromb Res 146:84–88PubMedGoogle Scholar
  75. Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES Jr (2001) Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. AJR Am J Roentgenol 176(1):119–122PubMedGoogle Scholar
  76. Sam JW, Jacobs JE, Birnbaum BA (2002) Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 22(6):1327–1334PubMedGoogle Scholar
  77. Savader SJ, Otero RR, Savader BL (1988) Puerperal ovarian vein thrombosis: evaluation with CT, US, and MR imaging. Radiology 167(3):637–639PubMedGoogle Scholar
  78. Sherard GB 3rd, Hodson CA, Williams HJ, Semer DA, Hadi HA, Tait DL (2003) Adnexal masses and pregnancy: a 12-year experience. Am J Obstet Gynecol 189(2):358–362; discussion 62–3PubMedGoogle Scholar
  79. Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J (1999) MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210(1):209–216PubMedPubMedCentralGoogle Scholar
  80. Umeoka S, Koyama T, Togashi K, Kobayashi H, Akuta K (2004) Vascular dilatation in the pelvis: identification with CT and MR imaging. Radiographics 24(1):193–208PubMedGoogle Scholar
  81. Ushakov FB, Elchalal U, Aceman PJ, Schenker JG (1997) Cervical pregnancy: past and future. Obstet Gynecol Surv 52(1):45–59PubMedGoogle Scholar
  82. Williams DR, Coller JA, Corman ML, Nugent FW, Veidenheimer MC (1981) Anal complications in Crohn’s disease. Dis Colon Rectum 24(1):22–24PubMedGoogle Scholar
  83. Willmott F, Allouni KA, Rockall A (2012) Radiological manifestations of metastasis to the ovary. J Clin Pathol 65(7):585–590PubMedGoogle Scholar
  84. Witlin AG, Mercer BM, Sibai BM (1996) Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology. J Matern Fetal Med 5(6):355–358PubMedGoogle Scholar
  85. Wolverson MK, Crepps LF, Sundaram M, Heiberg E, Vas WG, Shields JB (1983) Hyperdensity of recent hemorrhage at body computed tomography: incidence and morphologic variation. Radiology 148(3):779–784PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of RadiologyEpsom and St Helier University Hospitals NHS TrustLondonUK
  2. 2.Department of RadiologyThe Royal Marsden Hospital, NHS Foundation TrustLondonUK

Personalised recommendations