Original article
ACR Appropriateness Criteria® on Acute Pelvic Pain in the Reproductive Age Group

https://doi.org/10.1016/j.jacr.2008.12.004Get rights and content

Premenopausal women who present with acute pelvic pain frequently pose a diagnostic dilemma, exhibiting nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. Diagnostic considerations encompass multiple organ systems, including obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The selection of imaging modality is determined by the clinically suspected differential diagnosis. Thus, a careful evaluation of such a patient should be performed and diagnostic considerations narrowed before a modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice when an obstetric or gynecologic abnormality is suspected, and computed tomography is more useful when gastrointestinal or genitourinary pathology is more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies because of the lack of ionizing radiation.

Section snippets

Summary of Literature Review

Premenopausal women with acute pelvic pain often pose a diagnostic dilemma. They exhibit nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. The differential considerations encompass gynecologic and obstetric causes such as hemorrhagic ovarian cysts, pelvic inflammatory disease, ovarian torsion, ectopic pregnancy, impending miscarriage secondary to fetal distress or demise, and placental abruption, as well as nongynecologic etiologies, including

Conclusion

A woman in her reproductive years with acute pelvic pain presents a diagnostic challenge. Imaging, with ultrasound, CT, or MRI, is often integral to arriving at the correct diagnosis. However, the first step in the evaluation is to determine pregnancy status by measuring the serum β-hCG level. Next, the choice of the correct imaging test depends on the results of a careful clinical evaluation to narrow the differential diagnosis. Whether obstetric, gynecologic, gastrointestinal, urinary, or

Anticipated Exceptions

Nephrogenic systemic fibrosis (NSF), also known as nephrogenic fibrosing dermopathy, was first identified in 1997 and has recently generated substantial concern among radiologists, referring doctors, and laypeople. Until the past few years, gadolinium-based magnetic resonance contrast agents were widely believed to be almost universally well tolerated, extremely safe, and not nephrotoxic, even when used in patients with impaired renal function. All available experience suggests that these

Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level indication has been included for each imaging examination. The relative radiation levels are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk

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