Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond

Publication date: Available online 21 December 2016
Source:Current Problems in Diagnostic Radiology
Author(s): Lena Naffaa, Tejaswini Deshmukh, Shanthan Tumu, Chris Johnson, Kevin P. Boyd, Arthur B. Meyers
Identifying the etiology of acute pelvic pain in girls is often clinically challenging. Particularly in young girls it is often difficult to determine if acute pelvic symptoms are originating from a gynecologic source or from a genitourinary or gastrointestinal etiology based on the child′s clinical exam alone. Therefore, imaging plays a key role in establishing a diagnosis and in directing medical and surgical treatment. Pediatric gynecologic conditions which can present acutely with pain and/or mass include: ovarian torsion, hematometrocolpos, pelvic inflammatory disease, inguinal hernias containing an ovary and/or the uterus, adnexal cysts, pregnancy, vaginal foreign bodies and ovarian vein thrombosis. Sources of pelvic pain in girls from non- gynecologic etiologies include: appendicitis, distal ureterolithiasis and Crohn′s disease. Due to the lack of ionizing radiation, widespread availability, and lack of need for sedation grey scale and Doppler ultrasound examination is often the initial imaging obtained when there is suspicion of gynecologic pathology. Radiographs of the abdomen and pelvis are commonly used in the acute setting when there is concern for a bowel obstruction or free intraperitoneal air. Cross-sectional imaging with CT or MRI is used when the diagnosis remains unknown and to clarify findings found on ultrasound and radiographs. Correctly identifying and diagnosing the causes of acute pelvic pain in girls is crucial for the care of these patients. Here we review the spectrum of causes of acute pelvic pain in female infants to teens with emphasis on imaging approach and age-related characteristics.Objectiveso Review the normal anatomy, key anatomic relationships and age-related changes of the uterus and ovaries.o Discuss the appropriate choice of imaging for girls with acute pelvic pain.o Review the imaging of pelvic pathological conditions presenting in girls in the emergent clinical setting.o Differentiation of surgical from nonsurgical entities



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