The role of CT in acute pelvic pain of gynecologic origin in nonpregnant premenopausal women

Emergency, Genital / Reproductive system female, Pelvis, CT, CT-Angiography, MR, Arterial access, Contrast agent-intravenous, Surgery, Abscess, Acute, Haemorrhage Authors: D. I. Miftode, C. Lupascu-Ursulescu DOI: 10.26044/ecr2026/C-22939 Learning objectives To review the role of CT in the evaluation of acute pelvic pain of gynecologic origin To describe key CT findings in common gynecologic emergencies To emphasize the complementary role of CT to ultrasound in emergency settings

Acute pelvic pain in nonpregnant premenopausal women is a frequent and clinically challenging presentation in emergency settings, encompassing a wide spectrum of gynecologic and non-gynecologic etiologies. Prompt and accurate diagnosis is essential, as several gynecologic conditions may be life-threatening or fertility-threatening if not recognized early.Transvaginal ultrasound is the first-line imaging modality for suspected gynecologic pathology; however, its diagnostic performance may be limited by operator dependency, patient-related factors, and overlapping imaging features in acute presentations. In this context, computed tomography (CT) is increasingly utilized, particularly when... Findings and procedure details In non-pregnant reproductive-age women, the main etiologies include ovarian cyst rupture or hemorrhage, pelvic inflammatory disease, ovarian torsion, endometriosis and degeneration or torsion of uterine myomas.Hemorrhagic Ovarian CystsHemorrhagic ovarian cysts are common in premenopausal women and result from bleeding into a functional cyst. Acute pain may occur due to rapid cyst expansion or rupture.CT findings: Well-defined adnexal cystic lesion Hyperattenuating intracystic content reflecting acute blood Fluid–fluid levels in some cases Irregular or thickened cyst wall In cases of rupture, high-attenuation free intraperitoneal fluid consistent with...

Acute pelvic pain in nonpregnant premenopausal women represents a diagnostic emergency with a wide spectrum of gynecologic etiologies and significant clinical overlap. While ultrasound remains the first-line modality, CT is a critical second-line tool when initial imaging is inconclusive or when complications are suspected. CT provides rapid, comprehensive evaluation of the pelvis and abdomen, enabling confident identification of hemorrhage, ischemia, infection, and rupture across both common and uncommon gynecologic conditions. Recognition of key CT imaging patterns allows prompt diagnosis of life-threatening entities such as ovarian... Personal information and conflict of interest D. I. Miftode: Nothing to disclose C. Lupascu-Ursulescu: Nothing to disclose

1. "Saint Spiridon" Emergency County Hospital in Iasi, Romania - database.2. https://radiopaedia.org/3. https://radiologyassistant.nl/4. Basta Nikolic M, Spasic A, Hadnadjev Simonji D, Stojanović S, Nikolic O, Nikolic D. Imaging of acute pelvic pain. Br J Radiol. 2021 Nov 1;94(1127):20210281. doi: 10.1259/bjr.20210281. Epub 2021 Sep 7. PMID: 34491817; PMCID: PMC8553212.5. Mahesh Shetty, Acute Pelvic Pain: Role of Imaging in the Diagnosis and Management, Seminars in Ultrasound, CT and MRI, Volume 44, Issue 6, 2023, Pages 491-500, ISSN 0887-2171, https://doi.org/10.1053/j.sult.2023.10.004.6. Franco, P.N.; García-Baizán, A.; Aymerich, M.; Maino, C.;...