Imaging of Female Children and Adolescents with Abdominopelvic Pain Caused by Gynecological Pathologies


Key Points

■ The clinical presentation of abdominopelvic pain and gonadal pathologies is often nonspecific and therefore difficult to diagnose (limited evidence).

■ Surgical emergencies such as ovarian torsion should be considered when a girl presents with acute abdominopelvic pain (limited to moderate evidence).

■ In menstruating girls and adolescents, pregnancy (orthotopic or ectopic) should be considered as a cause of abdominopelvic discomfort/pain (limited evidence).

■ The initial imaging modality of choice for evaluating the uterus and adnexa is ultrasound (US) (limited to moderate evidence). If US is non-diagnostic and the clinical picture remains uncertain, MRI is the preferred next imaging test. CT may also be considered in patients with acute symptoms (limited evidence).

■ Other gynecological causes of abdominopelvic pain such as endometriosis and pelvic inflammatory disease have a significant impact on societal health care costs (limited to moderate evidence).

■ Various complications associated with tumors may lead to acute abdominopelvic pain (limited evidence).


Fallopian Tube Pelvic Pain Ectopic Pregnancy Ovarian Cyst Choledochal Cyst 
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. 1.
    Carrico CW, Fenton LZ, Taylor GA, DiFiore JW, Soprano JV. Am J Roentgenol 1999; 172: 513–516.Google Scholar
  2. 2.
    Hollmann AS, Macdonald S. In Carty H (ed.). Emergency Pediatric Radiology. Berlin: Springer, 1999; 217–232.Google Scholar
  3. 3.
    Klein MD, Rabbani AB, Rood KD et al. J Pediatr Surg 2001; 36:1375–1380.CrossRefPubMedGoogle Scholar
  4. 4.
    Puig S, Hörmann M, Rebhandl W, Felder-Puig R, Prokop M et al. Radiology 2003; 226:101–104.CrossRefPubMedGoogle Scholar
  5. 5.
    Strouse PJ. Singapore Med J 2003; 44:312–322.PubMedGoogle Scholar
  6. 6.
    Bailez MM. Semin Pediatr Surg 2007; 16:278–287.CrossRefPubMedGoogle Scholar
  7. 7.
    Rock JA, Schlaff WD. Fertil Steril 1985; 43:681–692.PubMedGoogle Scholar
  8. 8.
    Bhatt S, Kocakoc E, Dogra VS. Ultrasound Q 2006; 22:273–280.CrossRefPubMedGoogle Scholar
  9. 9.
    Woodward PJ, Sohaey R, Mezzetti TP, Jr. Radiographics 2001; 21:193–216; questionnaire 288–194.PubMedGoogle Scholar
  10. 10.
    Chatman DL, Ward AB. J Reprod Med 1982; 27:156–160.PubMedGoogle Scholar
  11. 11.
    Guo SW, Wang Y. Gynecol Obstet Invest 2006; 62:121–130.CrossRefPubMedGoogle Scholar
  12. 12.
    Guo SW, Wang Y. Fertil Steril 2006; 86:1584–1595.CrossRefPubMedGoogle Scholar
  13. 13.
    Black AY, Jamieson MA. Curr Opin Obstet Gynecol 2002;14:467–474.CrossRefPubMedGoogle Scholar
  14. 14.
    Vinatier D, Orazi G, Cosson M, Dufour P. Eur J Obstet Gynecol Reprod Biol 2001; 96: 21–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Laufer MR, Sanfilippo J, Rose G. J Pediatr Adolesc Gynecol 2003; 16:S3–S11.CrossRefPubMedGoogle Scholar
  16. 16.
    Ozkan S, Murk W, Arici A. Ann N Y Acad Sci 2008; 1127:92–100.CrossRefPubMedGoogle Scholar
  17. 17.
    Eskenazi B, Warner ML. Obstet Gynecol Clin North Am 1997; 24:235–258.CrossRefPubMedGoogle Scholar
  18. 18.
    Houston DE, Noller KL, Melton LJ 3rd, Selwyn BJ, Hardy RJ. Am J Epidemiol 1987; 125:959–969.Google Scholar
  19. 19.
    Matalliotakis IM, Cakmak H, Fragouli YG, Goumenou AG, Mahutte NG et al. Arch Gynecol Obstet 2008; 277:389–393.CrossRefPubMedGoogle Scholar
  20. 20.
    Kontoravdis A, Hassan E, Hassiakos D, Botsis D, Kontoravdis N et al. Clin Exp Obstet Gynecol 1999; 26:76–77.PubMedGoogle Scholar
  21. 21.
    Laufer MR, Goitein L, Bush M, Cramer DW, Emans SJ. J Pediatr Adolesc Gynecol 1997; 10:199–202.PubMedGoogle Scholar
  22. 22.
    Reese KA, Reddy S, Rock JA. J Pediatr Adolesc Gynecol 1996; 9:125–128.PubMedGoogle Scholar
  23. 23.
    Vercellini P, Fedele L, Arcaini L, Bianchi S, Rognoni MT et al. J Reprod Med 1989; 34:827–830.PubMedGoogle Scholar
  24. 24.
    Osuga Y, Koga K, Tsutsumi O et al. Gynecol Obstet Invest 2002; 53(Suppl 1):33–39,CrossRefPubMedGoogle Scholar
  25. 25.
    Paterson A. In Carty H (ed.). Imaging Children. Edinburgh, New York: Elsevier Churchill Livingstone, 2005;915–941.Google Scholar
  26. 26.
    Gray-Swain MR, Peipert JF. Curr Opin Obstet Gynecol 2006; 18:503–510.CrossRefPubMedGoogle Scholar
  27. 27.
    Ross J, Judlin P, Nilas L. European guideline for the management of pelvic inflammatory disease – Minor update August 2008.Google Scholar
  28. 28.
    Low N, McCarthy A, Macleod J et al. Health Technol Assess 2007; 11:iii–iv, ix–xii, 1–165.PubMedGoogle Scholar
  29. 29.
    Bevan CD, Johal BJ, Mumtaz G, Ridgway GL, Siddle NC. Br J Obstet Gynaecol 1995; 102:407–414.CrossRefPubMedGoogle Scholar
  30. 30.
    CDC. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51:1–78.Google Scholar
  31. 31.
    Morcos R, Frost N, Hnat M, Petrunak A, Caldito G. J Reprod Med 1993; 38:53–56.PubMedGoogle Scholar
  32. 32.
    Chang HC, Bhatt S, Dogra VS. Radiographics 2008; 28:1355–1368.CrossRefPubMedGoogle Scholar
  33. 33.
    Albayram F, Hamper UM. J Ultrasound Med 2001; 20:1083–1089.PubMedGoogle Scholar
  34. 34.
    Breech LL, Hillard PJ. Curr Opin Obstet Gynecol 2005; 17:483–489.CrossRefPubMedGoogle Scholar
  35. 35.
    Quillin SP, Siegel MJ. Radiographics 1993; 13:1281–1293; discussion 1294.PubMedGoogle Scholar
  36. 36.
    Bouguizane S, Bibi H, Farhat Y et al. J Gynecol Obstet Biol Reprod (Paris) 2003; 32:535–540.Google Scholar
  37. 37.
    Graif M, Itzchak Y. Am J Roentgenol 1988; 150:647–649.Google Scholar
  38. 38.
    Hata K, Hata T, Senoh D et al. Br J Obstet Gynaecol 1990; 97:163–166.CrossRefPubMedGoogle Scholar
  39. 39.
    Stark JE, Siegel MJ. Am J Roentgenol 1994; 163:1479–1482.Google Scholar
  40. 40.
    Burnett LS. Surg Clin North Am 1988; 68:385–398.PubMedGoogle Scholar
  41. 41.
    Hibbard LT. Am J Obstet Gynecol 1985; 152:456–461.PubMedGoogle Scholar
  42. 42.
    Houry D, Abbott JT. Ann Emerg Med 2001; 38:156–159.CrossRefPubMedGoogle Scholar
  43. 43.
    Mordehai J, Mares AJ, Barki Y, Finaly R, Meizner I. J Pediatr Surg 1991; 26:1195–1199.CrossRefPubMedGoogle Scholar
  44. 44.
    Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. J Ultrasound Med 1998; 17:83–89.PubMedGoogle Scholar
  45. 45.
    Littman ED, Rydfors J, Milki AA. Hum Reprod 2003; 18:1641–1642.CrossRefPubMedGoogle Scholar
  46. 46.
    Beaunoyer M, Chapdelaine J, Bouchard S, Ouimet A. J Pediatr Surg 2004; 39:746–749.CrossRefPubMedGoogle Scholar
  47. 47.
    Warner MA, Fleischer AC, Edell SL et al. Radiology 1985; 154:773–775.PubMedGoogle Scholar
  48. 48.
    Pomeranz AJ, Sabnis S. Pediatr Emerg Care 2004; 20:172–174.CrossRefPubMedGoogle Scholar
  49. 49.
    Cohen HL, Shapiro MA, Mandel FS, Shapiro ML. Am J Roentgenol 1993; 160:583–586.Google Scholar
  50. 50.
    Orbak Z, Kantarci M, Yildirim ZK, Karaca L, Doneray H. J Pediatr Endocrinol Metab 2007; 20:397–403.PubMedGoogle Scholar
  51. 51.
    Webb EM, Green GE, Scoutt LM. Radiol Clin North Am 2004; 42:329–348.CrossRefPubMedGoogle Scholar
  52. 52.
    Park SB, Kim JK, Kim KR, Cho KS. Radiographics 2008; 28:969–983.CrossRefPubMedGoogle Scholar
  53. 53.
    Comerci JT, Jr., Licciardi F, Bergh PA, Gregori C, Breen JL. Obstet Gynecol 1994; 84:22–28.PubMedGoogle Scholar
  54. 54.
    Kido A, Togashi K, Konishi I et al. Am J Roentgenol 1999; 172:445–449.Google Scholar
  55. 55.
    Outwater EK, Siegelman ES, Hunt JL. Radiographics 2001; 21:475–490.PubMedGoogle Scholar
  56. 56.
    Zane SB, Kieke BA, Jr., Kendrick JS, Bruce C. Matern Child Health J 2002; 6:227–236.CrossRefPubMedGoogle Scholar
  57. 57.
    RCOG. Why Mothers Die 1997–1999. The fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press, 2001.Google Scholar
  58. 58.
    Menon S, Sammel MD, Vichnin M, Barnhart KT. J Pediatr Adolesc Gynecol 2007; 20:181–185.CrossRefPubMedGoogle Scholar
  59. 59.
    Yeh JM, Hook EW, 3rd, Goldie SJ. Sex Transm Dis 2003; 30:369–378.CrossRefPubMedGoogle Scholar
  60. 60.
    Gao X, Outley J, Botteman M, Spalding J, Simon JA et al. Fertil Steril 2006; 86:1561–1572.CrossRefPubMedGoogle Scholar
  61. 61.
    Zhao SZ, Wong JM, Davis MB, Gersh GE, Johnson KE. Am J Manag Care 1998; 4: 1127–1134.PubMedGoogle Scholar
  62. 62.
    Simoens S, Hummelshoj L, D’Hooghe T. Hum Reprod Update 2007; 13:395–404.CrossRefPubMedGoogle Scholar
  63. 63.
    Kunz K, Kuppermann M, Moynihan C, Williamson A, Mazonson PT. Am J Managed Care 1995; 1:25–29.Google Scholar
  64. 64.
    Husby GK, Haugen RS, Moen MH. Acta Obstet Gynecol Scand 2003; 82:649–653.PubMedGoogle Scholar
  65. 65.
    Pandian Z, Bhattacharya S, Vale L, Templeton A. Cochrane Database Syst Rev 2005:CD003357.Google Scholar
  66. 66.
    Pashayan N, Lyratzopoulos G, Mathur R. BMC Health Serv Res 2006; 6:80.CrossRefPubMedGoogle Scholar
  67. 67.
    Philips Z, Barraza-Llorens M, Posnett J. Hum Reprod 2000; 15:95–106.CrossRefPubMedGoogle Scholar
  68. 68.
    Stones RW, Selfe SA, Fransman S, Horn SA. Baillieres Best Pract Res Clin Obstet Gynaecol 2000; 14:415–431.CrossRefPubMedGoogle Scholar
  69. 69.
    Ballard K, Lowton K, Wright J. Fertil Steril 2006; 86:1296–1301.CrossRefPubMedGoogle Scholar
  70. 70.
    Schenken RS. Fertil Steril 2006; 86:1305–1306; discussion 1317.CrossRefPubMedGoogle Scholar
  71. 71.
    Chiou SY, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. J Ultrasound Med 2007; 26:1289–1301.PubMedGoogle Scholar
  72. 72.
    Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Pediatr Radiol 2007; 37:446–451.CrossRefPubMedGoogle Scholar
  73. 73.
    Vijayaraghavan SB. J Ultrasound Med 2004; 23:1643–1649; quiz 1650–1641.PubMedGoogle Scholar
  74. 74.
    Bulas DI, Ahlstrom PA, Sivit CJ, Blask AR, O’Donnell RM. Radiology 1992; 183:435–439.PubMedGoogle Scholar
  75. 75.
    Sam JW, Jacobs JE, Birnbaum BA. Radiographics 2002; 22:1327–1334.CrossRefPubMedGoogle Scholar
  76. 76.
    Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I et al. Fertil Steril 2008; Epub ahead of print.Google Scholar
  77. 77.
    Mol BW, van der Veen F, Bossuyt PM. Hum Reprod 1999; 14:2855–2862.CrossRefPubMedGoogle Scholar
  78. 78.
    Gracia CR, Barnhart KT. Obstet Gynecol 2002; 97:464–470.CrossRefGoogle Scholar
  79. 79.
    Buckley RG, King KJ, Disney JD, Ambroz PK, Gorman JD et al. Acad Emerg Med 1998; 5:951–960.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Research Programm on Evidence-Based DiagnosticsInstitute of Public Health, Paracelsus Private Medical UniversitySalzburgAustria

Personalised recommendations