Skip to main content
SpringerLink
Log in

Acute and Chronic Pelvic Pain Disorders

  • Chapter
  • First Online:
MRI and CT of the Female Pelvis

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 1638 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • 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):294–297

    CAS  PubMed  Google Scholar 

  • 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):1243–1251

    Article  PubMed  Google Scholar 

  • 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):37–41

    CAS  PubMed  Google Scholar 

  • Arnoldussen CW (2015). Diagnostic imaging of pelvic congestive syndrome. In: de Wolf MA (ed), Phlebology. pp 67–72

    Google Scholar 

  • 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):491–496

    Article  CAS  PubMed  Google Scholar 

  • 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.0000000000000623

    Article  Google Scholar 

  • Atay Y, Altintas A, Tuncer I, Cennet A (2005) Ovarian actinomycosis mimicking malignancy. Eur J Gynaecol Oncol 26(6):663–664

    CAS  PubMed  Google Scholar 

  • Bazot M, Detchev R, Cortez A, Uzan S, Darai E (2003) Massive ovarian edema revealing gastric carcinoma: a case report. Gynecol Oncol 91(3):648–650

    Article  PubMed  Google Scholar 

  • Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22(4):785–801

    Article  PubMed  Google Scholar 

  • 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):461–470

    Article  PubMed  Google Scholar 

  • Berna JD, Garcia-Medina V, Guirao J, Garcia-Medina J (1996) Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging 21(1):62–64

    Article  CAS  PubMed  Google Scholar 

  • 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):267–273

    CAS  PubMed  Google Scholar 

  • 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):3224–3230

    Article  CAS  Google Scholar 

  • 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):1–108

    Article  Google Scholar 

  • 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):429–435

    Article  CAS  PubMed  Google Scholar 

  • Cobben LP, Groot I, Blickman JG, Puylaert JB (2003) Right colonic diverticulitis: MR appearance. Abdom Imaging 28(6):794–798

    Article  CAS  PubMed  Google Scholar 

  • Currarino G, Rutledge JC (1989) Ovarian torsion and amputation resulting in partially calcified, pedunculated cystic mass. Pediatr Radiol 19(6–7):395–399

    Article  CAS  PubMed  Google Scholar 

  • Dunnihoo DR, Gallaspy JW, Wise RB, Otterson WN (1991) Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 46(7):415–427

    Article  CAS  PubMed  Google Scholar 

  • Ferzoco LB, Raptopoulos V, Silen W (1998) Acute diverticulitis. N Engl J Med 338(21):1521–1526

    Article  CAS  PubMed  Google Scholar 

  • Filhastre M, Dechaud H, Lesnik A, Taourel P (2005) Interstitial pregnancy: role of MRI. Eur Radiol 15(1):93–95

    Article  CAS  PubMed  Google Scholar 

  • 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):537–540

    Article  CAS  PubMed  Google Scholar 

  • 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):2248–2257

    Article  PubMed  PubMed Central  Google Scholar 

  • 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):58–61

    Article  CAS  PubMed  Google Scholar 

  • Furukawa A, Saotome T, Yamasaki M, Maeda K, Nitta N, Takahashi M et al (2004) Cross-sectional imaging in Crohn disease. Radiographics 24(3):689–702

    Article  PubMed  Google Scholar 

  • Ghiatas AA (2004) The spectrum of pelvic inflammatory disease. Eur Radiol 14(Suppl 3):E184–E192

    PubMed  Google Scholar 

  • 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):619–625

    Article  CAS  PubMed  Google Scholar 

  • Gore RM, Balthazar EJ, Ghahremani GG, Miller FH (1996) CT features of ulcerative colitis and Crohn’s disease. AJR Am J Roentgenol 167(1):3–15

    Article  CAS  PubMed  Google Scholar 

  • Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P (2002) MR enteroclysis: technical considerations and clinical applications. Eur Radiol 12(11):2651–2658

    Article  PubMed  Google Scholar 

  • Graif M, Itzchak Y (1988) Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol 150(3):647–649

    Article  CAS  PubMed  Google Scholar 

  • 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):10–14

    Article  CAS  PubMed  Google Scholar 

  • 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):791–794

    Article  CAS  PubMed  Google Scholar 

  • Haque TL, Togashi K, Kobayashi H, Fujii S, Konishi J (2000) Adnexal torsion: MR imaging findings of viable ovary. Eur Radiol 10(12):1954–1957

    Article  CAS  PubMed  Google Scholar 

  • Hildyard CA, Gallacher NJ, Macklin PS (2013) Abdominopelvic actinomycosis mimicking disseminated peritoneal carcinomatosis. BMJ Case Rep 2013 DOI: 10.1136/bcr-2013-201128

    Google Scholar 

  • Horrow MM, White DS, Horrow JC (2003) Differentiation of perforated from nonperforated appendicitis at CT. Radiology 227(1):46–51

    Article  PubMed  Google Scholar 

  • Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20(2):399–418

    Article  CAS  PubMed  Google Scholar 

  • Kang JY, Melville D, Maxwell JD (2004) Epidemiology and management of diverticular disease of the colon. Drugs Aging 21(4):211–228

    Article  PubMed  Google Scholar 

  • 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):2644–2650

    Article  CAS  Google Scholar 

  • 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):503–508

    Article  CAS  PubMed  Google Scholar 

  • Kim SH, Kim SH, Yang DM, Kim KA (2004) Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 24(6):1575–1589

    Article  PubMed  Google Scholar 

  • Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J (1994) Ovarian torsion: CT and MR imaging appearances. Radiology 190(2):337–341

    Article  CAS  PubMed  Google Scholar 

  • Koonings PP, Grimes DA (1989) Adnexal torsion in postmenopausal women. Obstet Gynecol 73(1):11–12

    CAS  PubMed  Google Scholar 

  • 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):564–567

    Article  PubMed  Google Scholar 

  • 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):85–91

    Article  CAS  PubMed  Google Scholar 

  • Kuligowska E, Deeds L 3rd, Lu K 3rd (2005) Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics 25(1):3–20

    Article  PubMed  Google Scholar 

  • 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):331–336

    Article  CAS  PubMed  Google Scholar 

  • 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):393–397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee AR, Kim KH, Lee BH, Chin SY (1993) Massive edema of the ovary: imaging findings. AJR Am J Roentgenol 161(2):343–344

    Article  CAS  PubMed  Google Scholar 

  • 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):83–89

    Article  CAS  PubMed  Google Scholar 

  • Lopez AJ (2015) Female pelvic vein embolization: indications, techniques, and outcomes. Cardivasc Intervent Radiol 38(4):806–820

    Article  Google Scholar 

  • Machairiotis N, Stylianaki A, Kouroutou P, Sarli P, Alexiou NK, Efthymiou E et al (2016) Massive ovarian oedema: a misleading clinical entity. Diagn Pathol 11:18

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • 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):321–327

    Article  CAS  PubMed  Google Scholar 

  • 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):1433–1439

    Article  PubMed  Google Scholar 

  • 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):134–137

    Article  PubMed  Google Scholar 

  • 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):156–165

    Article  PubMed  Google Scholar 

  • Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M (2017) Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging 8(1):19–27

    Article  PubMed  Google Scholar 

  • 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):445–451

    Article  PubMed  Google Scholar 

  • 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):683–688

    Article  PubMed  Google Scholar 

  • Paulson EK, Kalady MF, Pappas TN (2003) Clinical practice. Suspected appendicitis. N Engl J Med 348(3):236–242

    Article  PubMed  Google Scholar 

  • 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):703–715

    Article  PubMed  Google Scholar 

  • 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):69–85

    Article  PubMed  Google Scholar 

  • 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):2064–2071

    Article  PubMed  Google Scholar 

  • Philpotts LE, Heiken JP, Westcott MA, Gore RM (1994) Colitis: use of CT findings in differential diagnosis. Radiology 190(2):445–449

    Article  CAS  PubMed  Google Scholar 

  • Pickhardt PJ, Bhalla S (2005) Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics 25(3):719–730

    Article  PubMed  Google Scholar 

  • Praveen R, Pallavi V, Rajashekar K, Usha A, Umadevi K, Bafna U (2013) A clinical update on massive ovarian oedema—a pseudotumour? Ecancermedicalscience 7:318

    PubMed  PubMed Central  Google Scholar 

  • 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):203–209

    Article  PubMed  Google Scholar 

  • 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):487–490

    Article  CAS  PubMed  Google Scholar 

  • Rao PM, Novelline RA (1999) Case 6: primary epiploic appendagitis. Radiology 210(1):145–148

    Article  CAS  PubMed  Google Scholar 

  • 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):686–692

    Article  CAS  PubMed  Google Scholar 

  • Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M (2016) Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics 36(5):1579–1596

    Article  PubMed  Google Scholar 

  • 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):283–294

    Article  PubMed  Google Scholar 

  • Riley GM, Babcook C, Jain K (1996) Ruptured malignant ovarian tumor mimicking ruptured ectopic pregnancy. J Ultrasound Med 15(12):871–873

    Article  CAS  PubMed  Google Scholar 

  • Roche O, Chavan N, Aquilina J, Rockall A (2012) Radiological appearances of gynaecological emergencies. Insights Imaging 3(3):265–275

    Article  PubMed  PubMed Central  Google Scholar 

  • 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):544–549

    Article  CAS  PubMed  Google Scholar 

  • Rottenstreich A (2016) Pregnancy and non-pregnancy related ovarian vein thrombosis: clinical course and outcome. Thromb Res 146:84–88

    Article  CAS  PubMed  Google Scholar 

  • 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):119–122

    Article  CAS  PubMed  Google Scholar 

  • Sam JW, Jacobs JE, Birnbaum BA (2002) Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 22(6):1327–1334

    Article  PubMed  Google Scholar 

  • Savader SJ, Otero RR, Savader BL (1988) Puerperal ovarian vein thrombosis: evaluation with CT, US, and MR imaging. Radiology 167(3):637–639

    Article  CAS  PubMed  Google Scholar 

  • 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 62–3

    Article  PubMed  Google Scholar 

  • 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):209–216

    Article  CAS  PubMed  Google Scholar 

  • 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):193–208

    Article  PubMed  Google Scholar 

  • Ushakov FB, Elchalal U, Aceman PJ, Schenker JG (1997) Cervical pregnancy: past and future. Obstet Gynecol Surv 52(1):45–59

    Article  CAS  PubMed  Google Scholar 

  • Williams DR, Coller JA, Corman ML, Nugent FW, Veidenheimer MC (1981) Anal complications in Crohn’s disease. Dis Colon Rectum 24(1):22–24

    Article  CAS  PubMed  Google Scholar 

  • Willmott F, Allouni KA, Rockall A (2012) Radiological manifestations of metastasis to the ovary. J Clin Pathol 65(7):585–590

    Article  PubMed  Google Scholar 

  • Witlin AG, Mercer BM, Sibai BM (1996) Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology. J Matern Fetal Med 5(6):355–358

    CAS  PubMed  Google Scholar 

  • 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):779–784

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Amy Davis

  2. Department of Radiology, The Royal Marsden Hospital, NHS Foundation Trust, London, UK

    Andrea Rockall

Authors
  1. Amy Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Rockall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy Davis .

Editor information

Editors and Affiliations

  1. Paracelsus Medical University, Salzburg, Austria

    Rosemarie Forstner

  2. Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

    Teresa Margarida Cunha

  3. Charité Universitätsmedizin, Humboldt University of Berlin, Berlin, Germany

    Bernd Hamm

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Davis, A., Rockall, A. (2017). Acute and Chronic Pelvic Pain Disorders. In: Forstner, R., Cunha, T.M., Hamm, B. (eds) MRI and CT of the Female Pelvis. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_103

Download citation

  • DOI: https://doi.org/10.1007/174_2017_103

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42573-3

  • Online ISBN: 978-3-319-42575-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation