Acute Pelvic Pain: Role of Imaging in the Diagnosis and Management

Acute pelvic pain is defined as a new symptom that has been present for less than 3 months. It is a common symptom seen in 15-24% of women and is the indication for 20% of laparoscopies and 2-10% of outpatient gynecologic visits. The pregnancy status and correlation of the physical symptoms with clinical findings is important. Ultrasound is the imaging modality of choice, not only to diagnose gynecological causes, but also bowel or urinary tract related causes of pelvic pain. When an ultrasound scan is inconclusive, a CT scan is the preferred means of additional imaging and is particularly useful in gastrointestinal and urogenital causes of pelvic pain. Gynecological causes of acute pelvic pain include uterine, tubal or ovarian pathology, non-gynecological causes include bowel diseases such as appendicitis and diverticulitis, urogenital causes such as ureteral, bladder stones and urinary tract infection as well as vascular causes. Ultrasound imaging alone may provide a definitive diagnosis in underlying conditions that require prompt medical or surgical intervention in gynecological conditions such as ovarian torsion, ectopic pregnancy and non-gynecological condition such as in acute appendicitis.