{"paper_id":"525316d9-aeab-424e-948b-399f4d2f55ce","body_text":"30\nYear XIII • No. 50 (4/2025)\ngynecology\nUltrasound assessment \nof acute pelvic pain: \ndiagnostic challenges across \ngynecological, surgical  \nand urological conditions\nBackground. Acute pelvic pain is a frequent clinical emer-\ngency, with an incidence of 15-24% among women, and \nmay result from both gynecological and surgical cau ses. \nDifferentiating between these conditions remains a di ag-\nnos tic challenge, as rapid and accurate identification of the \nunderlying pathology is essential for timely in ter ven tion. \nObjective. This study aims to analyze the role of ul tra sound \nin the differential diagnosis of acute pelvic pain, em pha-\nsi zing its accuracy, limitations and integration with com-\nple men tary imaging methods. Materials and method. A \nsys te ma tic literature review was conducted, in clu ding 13 \ncli ni cal studies, reviews and international guide lines pu-\nblished between 2000 and 2025, identified in PubMed, Sco-\npus and Web of Science. The search used key words such as \n“acute pelvic pain” , “gynecological causes” , “sur gi cal causes” , \n“ultrasound” and “differential diagnosis” . Data ex trac ted \nincluded diagnostic accuracy, clinical ap pli ca bi li ty and com-\npa rative imaging findings. Results. Ul tra sound emerged as \nthe first-line imaging method in acute pelvic pain eva lua-\ntion due to its accessibility, lack of io ni zing ra dia tion and the \nability to provide rapid diagnostic in for ma tion. The reported \nsensitivity ranged between 80% and 92%, and spe ci fi city \nranged between 85% and 95%, de pen ding on path o logy \nand operator expertise. Ultrasound de mon stra ted high \naccuracy in diagnosing ovarian torsion, ec to pic preg nancy \nand ruptured ovarian cysts, while CT and MRI proved ne ces-\nsary in inconclusive cases or in suspected gas tro in tes ti nal \nand urological conditions. Standardized clas si fi ca tions and \nconsensuses (IOTA, IDEA, #Enzian, Barnhart, Rettenbacher, \nMizuki et al.) enhanced diagnostic con sis tency and clinical \ndecision-making. Conclusions. Ul tra sound remains the \ncornerstone in the evaluation of acute pelvic pain, ef fec-\ntively guiding the differential diag no sis between gyne  co-\nlo gi cal and surgical conditions. Its in te gra tion with cli  ni  cal \ndata and, when necessary, with CT or MRI en sures op ti mal \npa tient management, minimizes diagnostic er rors, and \nre duces the risk of complications.\nKeywords: acute pelvic pain, ultrasound, differential \ndiagnosis, gynecological pathology, surgical pathology, \nurological pathology\nIntroducere. Durerea pelviană acută reprezintă o urgență \ncli ni că frecventă, cu o incidență de 15-24% la femei, având \netio lo gie ginecologică sau chirurgicală. Diferențierea dintre \naces te patologii rămâne o provocare diagnostică majoră, \nîn tru cât identificarea rapidă și corectă a cauzei este esențială \npen tru instituirea precoce a tratamentului adecvat. Obiectiv. \nSco pul studiului este de a analiza rolul ecografiei în diagnosticul \ndi fe ren țial al durerii pelviene acute, cu accent pe acuratețe, \nli mi tări și integrarea acesteia cu alte metode imagistice. \nMate ria le și metodă. A fost realizată o revizuire sistematică \na literaturii, incluzând 13 studii clinice, articole de revizuire și \nghi duri internaționale publicate între 2010 și 2025, identificate \nîn bazele de date PubMed, Scopus și Web of Science. Cuvintele-\ncheie utilizate au fost: „acute pelvic pain” , „gynecological causes” , \n„sur gi cal causes” , „ultrasound” şi „differential diagnosis” . Au \nfost extrase date privind acuratețea diagnostică, utilitatea \ncli ni că și comparația dintre metodele imagistice. Rezultate. \nEco gra fia s-a confirmat ca metodă imagistică de primă linie \nîn evaluarea durerii pelviene acute, datorită accesibilității, ab -\nsen ței radiațiilor ionizante și rapidității în furnizarea in for ma-\nții lor diagnostice. Sensibilitatea raportată a variat între 80% \nși 92%, iar specificitatea, între 85% și 95%, în funcție de tipul \npa to lo giei și experiența operatorului. Ecografia a demonstrat o \nacu ra tețe ridicată în diagnosticul torsionării ovariene, sarcinii \nec to pi ce și rupturii de chist ovarian, în timp ce CT-ul și RMN-ul \nau fost indicate în cazurile neconcludente sau la suspiciunea \nde patologie gastrointestinală ori urologică. Clasificările și \ncon sen su rile standardizate (IOTA, IDEA, #Enzian, Barnhart, \nRettenbacher, Mizuki și colab.) au contribuit la uni formizarea \ndiag nos ti cu lui și la facilitarea deciziilor clinice. Concluzii. \nEco  gra fia rămâne metoda esențială în evaluarea du re rii \npel vie ne acute, având un rol central în diferențierea din tre \npa  to lo gia ginecologică și cea chirurgicală. Integrarea re zul ta-\ntelor ecografice cu datele cli ni ce și, atunci când este necesar, cu \nin ves ti ga ții imagistice com ple men tare (CT, RMN) permite un \nma nage ment optim al pacientelor, reducerea erorilor diag nos ti-\nce și prevenirea com pli ca țiilor.\nCuvinte-cheie: durere pelviană acută, ecografie, diagnostic \ndiferențial, patologie ginecologică, patologie chirurgicală, \npatologie urologică\nAbstract RezumatIrina Burdeniuc1,  \nLiliana  \nFuior-Bulhac2,  \nIon Burdeniuc1,  \nCorina Darii1,  \nMihaela  \nUrusciuc1,  \nMirela Urzică1\n1. Department of Obstetrics, \nGynecology and Human \nReproduction,  \n“Nicolae Testemițanu”  \nState University of Medicine  \nand Pharmacy, Chișinău,  \nRepublic of Moldova\n2. Department of Radiology  \nand Imaging,  \n“Nicolae Testemițanu”  \nState University of Medicine  \nand Pharmacy, Chișinău,  \nRepublic of Moldova\nCorresponding author:  \nIrina Burdeniuc \nE-mail: iburdeniuc1@gmail.com\n\n31\nginecologia\nYear XIII • No. 50 (4/2025)\nEvaluarea ecografică a durerii pelviene acute: provocări diagnostice  \nîn diferențierea afecțiunilor ginecologice, chirurgicale și urologice\nSuggested citation for this article: Burdeniuc I, Fuior-Bulhac L, Burdeniuc I, Darii C, Urusciuc M, Urzică M. Ultrasound assessment of acute pelvic pain: diagnostic \nchallenges across gynecological, surgical and urological conditions. Ginecologia.ro. 2025;50(4):30-36.\nSubmission date:  \n15.11. 2025 \nAcceptance date: \n26.11.2025\nIntroduction\nAcute pelvic pain, defined as a newly developed symp-\ntom within the preceding three months, represents a \ncommon and clinically significant challenge in women’s \nhealth. It affects approximately 15-24% of women of \nreproductive age, and accounts for nearly 20% of laparo-\nscopic procedures and 2-10% of outpatient gynecological \nconsultations. Initial evaluation requires the determi -\nnation of pregnancy status and careful correlation of \nsymptoms with the clinical examination, both of which \nare critical for guiding subsequent diagnostic and thera-\npeutic decisions.\nAlthough most causes of acute pelvic pain are non-life-\nthreatening, conditions that endanger life or fertility must \nbe promptly recognized. In 2021, the global incidence of \nectopic pregnancy was approximately 213 per 100,000 \nwomen. Adnexal torsion accounted for 2.5-7.4% of acute \npelvic pain cases, while acute appendicitis remained the \nmost common abdominal surgical emergency, with an \nincidence of 214 per 100,000 population worldwide(1).\nUltrasound has established itself as the first-line im -\naging modality in the assessment of acute pelvic pain \ndue to its wide availability, absence of ionizing radia -\ntion, and ability to rapidly detect both gynecological and \nnongynecological causes, including intestinal and urogen-\nital conditions. In situations where ultrasound is incon-\nclusive, computed tomography (CT) provides a valuable \ncomplementary tool, particularly useful for identifying \ngastrointestinal and urinary tract pathologies, while \nmagnetic resonance imaging (MRI) may be reserved for \nselected cases requiring further diagnostic clarification.\nThe etiological spectrum of acute pelvic pain is broad. \nGynecological causes involve the uterus, fallopian tubes \nand ovaries, whereas nongynecological etiologies in -\nclude intestinal conditions (such as appendicitis and \ndiverticulitis), urological disorders (ureteral or bladder \ncalculi, urinary tract infections) and, less frequently, \nvascular diseases. In many instances, ultrasound ena -\nbles the rapid establishment of a precise diagnosis in \nemergencies that demand prompt medical or surgical \nintervention, such as ovarian torsion, ectopic pregnancy, \nor acute appendicitis.\nGynecological disorders are among the most frequent \netiologies of acute pelvic pain in women of reproductive \nage. The main causes include ectopic pregnancy, adnexal \ntorsion, ruptured or hemorrhagic ovarian cysts and pel-\nvic inflammatory disease (PID). Ectopic pregnancy re -\nmains a critical diagnosis due to the risk of rupture and \nTable 1 Common radiological findings in acute pelvic pain and suggested differential diagnosis(2)\nRadiological finding Differential diagnosis\nPeritoneal fluid Ovarian cyst rupture, ovarian torsion, ovarian hyperstimulating syndrome, ruptured ectopic pregnancy, \nmittelschmerz, PID, appendicitis, colonic diverticulitis, ovarian carcinoma\nFat stranding\nIleocecal Appendicitis, Crohn’s disease\nPericolic Colonic diverticulitis, epiploic appendagitis, omental infarction\nPeriileal Crohn’s disease, regional enteritis, omental infarction\nPelvic PID, endometriosis, iliac aneurysm rupture\nPerirenal Pyelonephritis\nBowel distension Volvulus, incarcerated hernia, intussusception\nPneumoperitoneum Intestinal perforation, colonic diverticulitis, appendicitis\nRetropneumoperitoneum Emphysematous pyelonephritis, perinephric abscess\nPelvic mass Gynecological malignancy, degenerated myoma, endometrioma, extrauterine pregnancy, \nperiappendicular abscess, peridiverticular abscess, iliac aneurysm\nKidney enlargement Perinephritic abscess, pyelonephritis\nRetroperitoneal hematoma Aortic/iliac aneurysm rupture, perirenal hematoma\n\n32\nYear XIII • No. 50 (4/2025)\ngynecology\nmaternal morbidity, with an estimated global incidence \nof 342.44 per 100,000 women. Adnexal torsion accounts \nfor 2.5-7.4% of cases of acute pelvic pain, and requires \nprompt surgical intervention to preserve ovarian func -\ntion. Ruptured or hemorrhagic cysts typically cause sud-\nden, unilateral pelvic pain, sometimes accompanied by \nmild intraperitoneal bleeding. PID, most often due to \nascending bacterial infection, leads to bilateral pain, \nfever and cervical tenderness, with potential long-term \nconsequences such as infertility (3).\nUltrasound plays a central role in the rapid identifica-\ntion of these conditions, allowing distinction between \ngynecological and nongynecological causes, and guiding \nthe appropriate management.\nSurgical pathologies represent an important subset of \nacute pelvic pain and often require prompt intervention. \nAcute appendicitis is the most frequent, presenting with \nright lower quadrant pain, nausea, vomiting and low-\ngrade fever; delayed diagnosis may lead to perforation \nor peritonitis. Diverticulitis can mimic gynecological \npain, causing lower abdominal discomfort, fever and \naltered bowel habits, occasionally requiring surgical \nmanagement for complications. Intestinal obstruction, \ndue to adhesions, hernia or volvulus, presents with dif -\nfuse abdominal pain, distension and vomiting, and may \nprogress to ischemia or perforation if untreated.\nUltrasound serves as a first-line imaging modality, \naiding in the rapid detection of appendiceal inflamma -\ntion, bowel wall thickening, fluid collections and other \nsurgical abnormalities, thereby supporting early diag -\nnosis and timely management.\nUrological disorders represent an important compo -\nnent of the differential diagnosis of acute pelvic pain. \nThe most frequent causes include urolithiasis and uri -\nnary tract infections (UTIs). Urolithiasis, particularly \nureteral calculi, is a frequent cause of acute pelvic pain, \nwith global incidence estimates ranging from 114 to over \n700 cases per 100,000 population, according to recent \nmultinational epidemiological data. UTIs afflict up to \n30-40% of women of reproductive age, presenting with \nsuprapubic pain, dysuria and urinary frequency. Less fre-\nquent etiologies include interstitial cystitis and urinary \nretention. Ultrasound remains the first-line imaging \nmodality, allowing the rapid detection of hydronephro -\nsis, bladder wall changes and intraluminal calculi (4).\nTherefore, ultrasound remains a cornerstone in the \ndifferential diagnosis of gynecological versus surgical \ncauses of acute pelvic pain, supporting the timely iden -\ntification of patients requiring urgent intervention and \nguiding optimal clinical management.\nAim of the study\nThe aim of this study is to analyze the challenges of \ndifferential diagnosis between gynecological and surgi -\ncal pathologies in patients presenting with acute pelvic \npain and to highlight the role of ultrasound as a first-\nline tool in the rapid identification of underlying causes, \nthereby facilitating appropriate therapeutic decision-\nmaking and optimizing clinical management.\nMaterials and method\nThe study was conducted through an analysis of the \nspecialized literature on acute pelvic pain and the role of \nultrasound in the differential diagnosis between gyneco-\nlogical and surgical pathology. Articles published between \n2000 and 2025 were included, accessed from international \ndatabases such as PubMed, Scopus and Web of Science, \nusing search terms such as “acute pelvic pain”, “gyneco-\nlogical causes”, “surgical causes”, “urological causes”, “ul-\ntrasound”, “differential diagnosis” and “imaging.”\nA total of 14 relevant studies were selected, including \nreviews, international guidelines, clinical and observa -\ntional studies, addressing the frequency, etiology and \nmanagement of acute pelvic pain, with a focus on the \nusefulness of ultrasound in the early diagnosis of con -\nditions requiring prompt intervention, such as ovarian \ntorsion, ectopic pregnancy, or acute appendicitis.\nFor each included study, demographic parameters, \ntype of imaging investigations used, diagnostic accuracy \nof ultrasound, intervention times and clinical outcomes \nwere analyzed. The data were synthesized descriptively \nand comparatively, highlighting the role of ultrasound \nas a first-line method and its limitations in the context \nof the differential diagnosis between gynecological and \nsurgical pathology.\nResults\nThe analysis of the 14 included studies, presented \nin Table 2, demonstrated that ultrasound represents \nthe first-line imaging method in the evaluation of acute \npelvic pain, due to its high accessibility, absence of ion -\nizing radiation and ability to rapidly provide essential \nclinical information for therapeutic decision-making. \nAccording to the data summarized in Table 3, the sensi-\ntivity of ultrasound ranged between 80% and 92%, while \nspecificity ranged between 85% and 95%. These values \nwere influenced by the type of pathology investigated, \nthe imaging technique used (transabdominal or trans -\nvaginal) and the operator’s experience.\nAccording to Table 3, ultrasound demonstrates par -\nticularly high diagnostic accuracy for gynecological \nemergencies such as ovarian torsion, ectopic pregnancy \nand ruptured ovarian cysts. Prompt identification of \nthese conditions facilitates timely surgical or medical \nmanagement, thereby reducing the risk of severe com -\nplications, including ovarian loss or life-threatening \nhemorrhage. Additionally, ultrasound provides valuable \nclinical information in the assessment of other acute \ngynecological conditions, including pelvic inflammatory \ndisease, ovarian hematoma and intrauterine bleeding, \nsupporting informed therapeutic decision-making.\nIn nongynecological pathologies, ultrasound has \nshown diagnostic utility in acute appendicitis, ureteral \nlithiasis, and urinary tract infections. Nevertheless, its \naccuracy may be affected by patient-related factors such \nas body habitus, anatomical variations, or the clinical \nsetting, as well as by operator expertise. In diagnostical-\nly inconclusive cases, or when complex intestinal pathol-\nogy is suspected, complementary imaging modalities \n\n33\nginecologia\nYear XIII • No. 50 (4/2025)\nsuch as computed tomography or magnetic resonance \nimaging are recommended. These modalities enhance \nboth sensitivity and specificity, and play a pivotal role \nin guiding appropriate therapeutic strategies.\nInternational guidelines and systematic reviews con-\nsistently highlight that a multimodal imaging approach \n– integrating ultrasound with CT or MRI – optimizes \ndiagnostic accuracy, minimizes delays in diagnosis and \nreduces the incidence of complications, including the \nneed for unplanned surgical interventions.\nAcross all reviewed studies, ultrasound was consist -\nently recognized for its rapid applicability, widespread \navailability in emergency and gynecological settings, and \nthe absence of ionizing radiation. These advantages rein-\nforce its central role as the primary imaging modality in \nthe differential diagnosis of acute pelvic pain, enabling \nprompt recognition of urgent cases and contributing \nto improved clinical outcomes and optimized patient \nmanagement.\nDiscussion\nThe analysis of the specialized literature and the in -\ntegration of data from Table 4 emphasize the essential \nrole of ultrasound in the differential diagnosis of acute \npelvic pain, both for gynecological and for surgical or \ngastrointestinal pathology. Ultrasound remains the \nfirst-line imaging modality owing to its accessibility, \nabsence of ionizing radiation and rapid provision of clini-\ncally relevant information, thereby facilitating prompt \ntherapeutic decision-making.\nIn the case of ovarian tumors and cysts, the use of \nIOTA (International Ovarian Tumor Analysis, 2016) \nTable 2 Studies included in the analysis of the role of ultrasound in the diagnosis of acute pelvic pain\nNo Author(s), year Study type Aim/objective\n1 Franco et al., 2023(6) Review Analyzes common gynecological causes of acute pelvic pain, including pelvic \ninflammatory disease, ruptured ovarian cysts and ovarian torsion.\n2 Kruszka and Boulanger, 2010(7) Clinical article Evaluation of acute pelvic pain in women, including pelvic inflammatory disease, \nruptured ovarian cysts and appendicitis.\n3 Gopireddy et al., 2022(8) Illustrated review Analysis of the use of MRI imaging in the evaluation of acute pelvic pain, \nparticularly of gynecological origin.\n4 Brook et al., 2024(9) Guideline Appropriateness criteria for imaging in acute pelvic pain in women  \nof reproductive age.\n5 Domínguez et al., 2017(10) Clinical article Gynecological pelvic pain as an emergency condition: functional cysts, ectopic \npregnancy, pelvic inflammatory disease, ovarian torsion.\n6 Basta Nikolic et al., 2021(11) Review The role of imaging in the evaluation of acute pelvic pain, emphasizing  \nthe importance of ultrasound as the first-line method.\n7 Henrichsen et al., 2021(12) Guideline Appropriateness criteria for imaging in acute pelvic pain in postmenopausal \nwomen.\n8 Potter et al., 2008(13) Comparative study Comparison of ultrasound and CT use in the evaluation of acute pelvic pain  \nof gynecological origin.\n9 Kaakaji et al., 2000(14) Clinical article The use of ultrasound in obstetric and gynecological emergencies,  \nincluding acute pelvic pain.\n10 Pacione, 2023(15) Review Analysis of different imaging modalities in the non-pregnant female pelvis, \nincluding ultrasound, CT and MRI.\n11 Dewey and Wittrock, 2019(16) Clinical article Evaluation of acute pelvic pain, including gynecological and nongynecological \ncauses, and the role of imaging.\n12 Frasca et al., 2023(17) Clinical study Evaluation of acute pelvic pain in women, discussing common causes  \nand the importance of imaging.\n13 Luntsi, 2015(18) Retrospective study Analysis of common gynecological ultrasound patterns in women with pelvic pain \nin a tertiary hospital in Nigeria.\n14 Shebl et al., 2017(19) Narrative review Discusses bladder pain syndrome (BPS) presenting with pain, dysuria, urgency – \nimportant in differential diagnosis of pelvic pain.\n\n34\nYear XIII • No. 50 (4/2025)\ngynecology\ncri teria allows morphological characterization of ad -\nnexal lesions (simple, hemorrhagic, or complex cysts) \nand application of the ADNEX model, offering a clear \ndistinction between benign and malignant lesions, \nand reducing diagnostic errors (20). For deep infiltrating \nendometriosis (DIE), the IDEA consensus (2016) and \nthe #Enzian classification (2021) provide a systematic \nultrasonographic evaluation of pelvic compartments, \nincluding the pouch of Douglas, uterosacral ligaments \nand bowel wall, thereby standardizing terminology and \nfacilitating correlation with laparoscopic findings (21,22).\nIn ectopic pregnancy, the Barnhart classification \n(2013) establishes standardized ultrasonographic cri -\nteria for visible gestational sac, nonspecific adnexal mass \nand pregnancy of unknown location (PUL), optimiz -\ning correlation with hCG values and supporting timely \nclinical decision-making (23). For acute appendicitis, the \nRettenbacher classification (2002) defines specific ultra-\nsonographic parameters, such as appendiceal diameter \nabove 6 mm, non-compressibility, and the presence of \ncomplications (abscess, perforation), thereby facilitating \nthe differential diagnosis between gynecological and \nnongynecological causes of acute pelvic pain (24).\nIn colonic pathology and diverticulitis, local ultra -\nsonographic classifications (Mizuki et al., 2018) enable \nthe identification of intestinal wall thickening above 5 \nmm, loss of stratification and pericolic inflammation, \ncontributing to differentiation from endometriosis \nor pelvic masses (25). These consensuses and classifica -\ntions demonstrate that the integration of standardized \nultrasonographic approaches enhances diagnostic accu-\nracy and allows clearer communication between radiolo-\ngists and clinicians.\nOverall, the reviewed studies confirm that when ul -\ntrasound is applied in accordance with international \nprotocols and consensuses, it optimizes the differential \ndiagnosis, reduces the risk of complications, and limits \nthe need for additional imaging investigations. This has \na direct impact on the management of patients present-\ning with acute pelvic pain.\nConclusions\nUltrasound is confirmed as the first-line imaging \nmodality in the evaluation of acute pelvic pain, owing \nto its rapidity, accessibility and absence of ionizing radia-\ntion, providing essential clinical information for timely \ntherapeutic decision-making. Sensitivity and specificity \nvalues, ranging from 80-92% and 85-95%, respectively, \ndemonstrate the accuracy of ultrasound in diagnosing \nmajor gynecological causes, including ovarian torsion, \nectopic pregnancy and ruptured ovarian cysts.\nFor nongynecological pathologies, ultrasound re -\nmains useful; however, computed tomography and \nmagnetic resonance imaging are recommended in in -\nconclusive cases or when patient anatomy is complex, \nhighlighting the importance of a multimodal imaging \napproach. The application of standardized ultrasono -\ngraphic consensuses and classifications – including \nIOTA, IDEA, #Enzian, Barnhart, Rettenbacher, and \nMizuki et al. – enhances diagnostic accuracy, facilitates \nCause Imaging method Sensitivity (%) Specificity (%) Observations\nOvarian torsion Transvaginal \nultrasound 92 95 Enables rapid diagnosis and urgent \nsurgical intervention.\nEctopic pregnancy Transvaginal \nultrasound 90 94 Early detection reduces the risk  \nof hemorrhagic complications.\nRuptured ovarian cyst Ultrasound 88 90 Identifies most cases with clear \nultrasonographic signs.\nPelvic inflammatory disease Ultrasound 85 88 Allows identification of collections \nor pelvic inflammation.\nAcute appendicitis Ultrasound 85 88 CT improves accuracy  \nin inconclusive cases.\nUreteral lithiasis Ultrasound 82 89 CT detects small ureteral stones  \nor complex situations.\nUrinary tract infections/hydronephrosis Ultrasound 80 85 Ultrasound highlights dilatation  \nor renal changes.\nComplex nongynecological causes Ultrasound + CT/MRI 90-95 96-99\nA multimodal approach optimizes \ndiagnostic accuracy and guides \ntherapy.\nTable 3 Sensitivity and specificity of ultrasound and other imaging methods in various causes  \nof acute pelvic pain\n\n35\nginecologia\nYear XIII • No. 50 (4/2025)\ncommunication between clinicians and radiologists, and \nallows the precise correlation with surgical or laparo -\nscopic findings.\nFurthermore, ongoing operator training and adher -\nence to standardized protocols are essential for optimiz-\ning ultrasound performance and minimizing diagnostic \nerrors. Overall, ultrasound, integrated with clinical data \nand, when appropriate, complementary imaging, consti-\ntutes the primary tool in the management of patients \nwith acute pelvic pain, providing an effective differential \ndiagnosis and contributing to the prevention of compli-\ncations.   n\nTable 4 Ultrasonographic classifications and consensuses used in the evaluation of acute pelvic \npathologies and their clinical utility\nPathology Classification/consensus Year/group Ultrasonographic features \ndescribed Clinical utility\nOvarian tumors/cysts IOTA (International Ovarian \nTumor Analysis)(15) 2016\nMorphology of adnexal lesions \n(simple, hemorrhagic, complex \ncysts), simple rules, ADNEX score\nDifferentiation between benign \nand malignant lesions; reduction \nof diagnostic errors\nDeep infiltrating \nendometriosis (DIE)\nIDEA consensus (International \nDeep Endometriosis Analysis)(16) 2016\nUterus, ovaries, pouch  \nof Douglas, rectovaginal septum, \nbowel wall, sliding sign\nStandardized terminology  \nfor ultrasound reporting\n#Enzian Classification \n(echography)(17) 2021\nPelvic compartments  \n(A – vaginal/rectovaginal,  \nB – uterosacral ligaments,  \nC – rectum), extent of DIE\nUniform description of lesion \nextent and correlation  \nwith laparoscopic findings\nEctopic pregnancy Barnhart Classification (18) 2013\nVisible gestational sac, \nnonspecific adnexal mass, \npregnancy of unknown location \n(PUL)\nStandardization  \nof ultrasonographic diagnosis \nand correlation with hCG values\nAcute appendicitis Rettenbacher Classification (19) 2002\nNormal appendix, early \nappendicitis  \n(>6 mm, non-compressible), \ncomplicated appendicitis \n(abscess, perforation)\nUltrasonographic differential \ndiagnosis in acute pelvic pain\nDiverticulitis/colonic \npathology\nLocal ultrasonographic \nclassifications  \n(Mizuki et al.)(25)\n2005\nGrade I: inflamed diverticulum \nwith pericolic inflammation  \nand an abscess ≤2 cm. \nGrade II: abscess >2 cm  \nand/or pneumoperitoneum\nDifferentiation from \nendometriosis or pelvic masses\nUrolithiasis/\nobstructive uropathy\nUTD (Urinary Tract Dilation) \nClassification (prenatal/\npostnatal) & standard grading \nof hydronephrosis/stone-related \nobstruction (24)\n2014  \n(UTD consensus) \n& various \nsubsequent \nupdates\nRenal pelvis AP diameter, \ncalyceal dilation, ureteral \ndilation, parenchymal changes, \nbladder abnormalities\nComprehensive evaluation  \nof urinary tract obstruction; \naids in correlating ultrasound \nfindings with clinical symptoms \nin pelvic pain and planning \nfurther interventions\n1. Wei N, Peng L, Chen Y, Wang B, Yang J. Global and China burden of ectopic \npregnancy (1990-2021): Trends, patterns, and future projections. J Obstet \nGynaecol Res. 2025;51(7):e70005. \n2. Nikolic MB, Spasic A, Simonji DH, Stojanović S, Nikolic O, Nikolic D. Imaging of \nacute pelvic pain, Brit J Radiol. 2021;94(1127):20210281.\n3. He D, Wang T, Ren W. Global burden of pelvic inflammatory disease and ectopic \npregnancy from 1990 to 2019. BMC Public Health. 2023;23(1):1894.\n4. Yao W, Wei X, Jing Q, Yuan X, Liu F, Zhang X. Epidemiological trends of \nurolithiasis in working-age populations: Findings from the global burden of \ndisease study 1990-2021. PLoS One. 2025;20(7):e0327343.\n5. Shetty MK. Acute pelvic pain: role of imaging in the diagnosis and management. \nSemin Ultrasound, CT MR. 2023;44(6):491-500.\n6. Franco PN, García-Baizán A, Aymerich M, Maino C, Frade-Santos S, Ippolito D, \nOtero-García M. Gynaecological causes of acute pelvic pain: common and not-\nso-common imaging findings. Life (Basel). 2023;13(10):2025. \n7. Kruszka PS, Boulanger BR. Evaluation of acute pelvic pain in women. Am Fam \nPhysician. 2010;82(6):614-22.\n8. Gopireddy DR, Virarkar M, Kumar S, Vulasala SSR, Nwachukwu C, Lamsal S. Acute \npelvic pain: A pictorial review with magnetic resonance imaging. J Clin Imaging \nSci. 2022;12:48.\n9. Expert Panel on GYN and OB Imaging, Brook OR, Dadour JR, et al. ACR \nAppropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: \n2023 Update. J Am Coll Radiol. 2024;21(6S):S3-S20. \n10. Domínguez F, Mora Jurado A, García de la Oliva A, de Araujo Martins-Romeo D, \nReferences\n\n36\nYear XIII • No. 50 (4/2025)\nAbonații la revista Viața Medicală p rimesc:\n 5 EMC - membrii Colegiului Medicilor Stomatologi din România \n 10 EFC - membrii Colegiului Farmaci/uni0219tilor din România \n 5 EMC - membrii OAMGMAMR\n 7 FPC - membrii OBBCSSR\nB e n e fic i e z i d e o f e rta  s pecială : \n1 2 v o lum e d e s pecia l ita t e \ng r a t uit e , î n f o r m a t  d i g i t a l !\nP R O FITA/uni021AI d e \nr e d u c e r e p ân ă l a \n31 d e c e m brie  2 02 5\nAbonamente Combo*\nformate din revista Viața Medicală\n \no revistă la alegere dintre: \nMedic.ro, Farmacist.ro, Psihiatru.ro, ORL.ro, Pediatru.ro, \nGinecologia.ro, Oncolog- Hematolog.ro, Alergologia, \nThe Romanian Journal of Nutrition.\n*Abonamentele Combo oferă 10 EMC pentru medici, credite suplimentare \npentru farmaci/uni0219ti, asisten/uni021Bi /uni0219i moa/uni0219e /uni0219i EMCD  pentru dieteticieni\nCombo t ipărit  399 lei\npână l a 3 1 dec 2 025  359 lei\nCombo PDF 259 lei\npână l a 3 1 dec 2 025  220 lei\nAbonament revistă tipărită \n4 ed i/uni021Bi i t i păr i t e & P DF  \n+ 2 ed i/uni021Bi i elec t r oni c e  200 lei\n » P r e /uni021B redu s p ână l a 3 1 dec. 2 025  160 lei\nAbonament digital \n6 ed i/uni021Bi i P DF / a n  120 lei\n » P r e /uni021B redu s p ână l a 3 1 dec. 2 025  100 lei\nwww.viata-medicala.ro/abonamente\nRevistă de opinie și informare a breslei medicale din România\ngynecology\nCueto Álvarez L. 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Dewey K, Wittrock C. Acute pelvic pain. Emerg Med Clin North Am. \n2019;37(2):207-18. \n17. Frasca DJ, Jarrio CE, Perdue J. Evaluation of Acute Pelvic Pain in Women. Am Fam \nPhysician. 2023;108(2):175-180. \n18. Luntsi G. Pattern of Gynaecological Pelvic Ultrasound Findings among Women \nwith Pelvic Pain in a Tertiary Hospital in Kano, North Western Nigeria. J Dental \nMed Sci. 2015;14(7):79-82\n19. Shebl SE, Dawood AS, Dawood AGS. Bladder pain syndrome from \nurogynecological point of view: a narrative. Int J Reprod, Contracept, Obstet \nGynecol. 2017;6(5):1694–702.\n20. Cherukuri S, Jajoo S, Dewani D. The International Ovarian Tumor Analysis-\nAssessment of Different Neoplasias in the Adnexa (IOTA-ADNEX) Model \nAssessment for Risk of Ovarian Malignancy in Adnexal Masses. Cureus. \n2022;14(11):e3119 4. \n21. Indrielle-Kelly T, Frühauf F, Fanta M, Burgetova A, Lavu D, Dundr P, Cibula D, \nFischerova D. Application of International Deep Endometriosis Analysis (IDEA) \ngroup consensus in preoperative ultrasound and magnetic resonance imaging \nof deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2020;56(1):115-6.\n22. Keckstein J, Hudelist G. Classification of deep endometriosis (DE) including \nbowel endometriosis: From r-ASRM to #Enzian-classification. Best Pract Res Clin \nObstet Gynaecol. 2021;71:27-37. \n23. Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361(4):379-\n87.\n24. Hoffmann JC, Trimborn CP, Hoffmann M, Schröder R, Förster S, Dirks K, \nTannapfel A, Anthuber M, Hollerweger A. Classification of acute appendicitis \n(CAA): treatment directed new classification based on imaging (ultrasound, \ncomputed tomography) and pathology. Int J Colorectal Dis. 2021;36(11):2347-60.\n25. Mizuki A, Kaneda S, Tatemichi M, Nakazawa A, Tsukada N, Nagata H, Kanai T. \nValidation by CT of the new ultrasonography classification of acute colonic \ndiverticulitis among Japanese patients. Cogent Medicine. 2018;5(1):1507478. \nReferences\nThis work is permanently accessible \nonline free of charge and published \nunder the CC-BY.\nCONFLICT OF INTERESTS:  none declared.\nFINANCIAL SUPPORT:  none declared.","source_license":"CC0","license_restricted":false}