Ultrasound assessment of acute pelvic pain: diagnostic challenges across gynecological, surgical and urological conditions

acute pelvic pain, ultrasound, differential diagnosis, gynecological pathology, surgical pathology, urological pathology Introducere. Durerea pelviană acută reprezintă o urgență cli ni că frecventă, cu o incidență de 15-24% la femei, având etio lo gie ginecologică sau chirurgicală. Diferențierea dintre aces te patologii rămâne o provocare diagnostică majoră, în tru cât identificarea rapidă și corectă a cauzei este esențială pen tru instituirea precoce a tratamentului adecvat. Obiectiv. Sco pul studiului este de a analiza rolul ecografiei în diagnosticul di fe ren țial al durerii pelviene acute, cu accent pe acuratețe, li mi tări și integrarea acesteia cu alte metode imagistice. Mate ria le și metodă. A fost realizată o revizuire sistematică a literaturii, incluzând 13 studii clinice, articole de revizuire și ghi duri internaționale publicate între 2010 și 2025, identificate în bazele de date PubMed, Scopus și Web of Science. Cuvintele- cheie utilizate au fost: „acute pelvic pain” , „gynecological causes” , „sur gi cal causes” , „ultrasound” şi „differential diagnosis” . Au fost extrase date privind acuratețea diagnostică, utilitatea cli ni că și comparația dintre metodele imagistice. Rezultate. Eco gra fia s-a confirmat ca metodă imagistică de primă linie în evaluarea durerii pelviene acute, datorită accesibilității, ab - sen ței radiațiilor ionizante și rapidității în furnizarea in for ma- ții lor diagnostice. Sensibilitatea raportată a variat între 80% și 92%, iar specificitatea, între 85% și 95%, în funcție de tipul pa to lo giei și experiența operatorului. Ecografia a demonstrat o acu ra tețe ridicată în diagnosticul torsionării ovariene, sarcinii ec to pi ce și rupturii de chist ovarian, în timp ce CT-ul și RMN-ul au fost indicate în cazurile neconcludente sau la suspiciunea de patologie gastrointestinală ori urologică. Clasificările și con sen su rile standardizate (IOTA, IDEA, #Enzian, Barnhart, Rettenbacher, Mizuki și colab.) au contribuit la uni formizarea diag nos ti cu lui și la facilitarea deciziilor clinice. Concluzii. Eco gra fia rămâne metoda esențială în evaluarea du re rii pel vie ne acute, având un rol central în diferențierea din tre pa to lo gia ginecologică și cea chirurgicală. Integrarea re zul ta- telor ecografice cu datele cli ni ce și, atunci când este necesar, cu in ves ti ga ții imagistice com ple men tare (CT, RMN) permite un ma nage ment optim al pacientelor, reducerea erorilor diag nos ti- ce și prevenirea com pli ca țiilor. Cuvinte-cheie: durere pelviană acută, ecografie, diagnostic diferențial, patologie ginecologică, patologie chirurgicală, patologie urologică

RezumatIrina Burdeniuc1, Liliana Fuior-Bulhac2, Ion Burdeniuc1, Corina Darii1, Mihaela Urusciuc1, Mirela Urzică1 1. Department of Obstetrics, Gynecology and Human Reproduction, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova 2. Department of Radiology and Imaging, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova Corresponding author: Irina Burdeniuc E-mail: [email protected] 31 ginecologia Year XIII • No. 50 (4/2025) Evaluarea ecografică a durerii pelviene acute: provocări diagnostice în diferențierea afecțiunilor ginecologice, chirurgicale și urologice Suggested citation for this article: Burdeniuc I, Fuior-Bulhac L, Burdeniuc I, Darii C, Urusciuc M, Urzică M. Ultrasound assessment of acute pelvic pain: diagnostic challenges across gynecological, surgical and urological conditions. Ginecologia.ro. 2025;50(4):30-36. Submission date: 15.11. 2025 Acceptance date: 26.11.2025

Acute pelvic pain, defined as a newly developed symp- tom within the preceding three months, represents a common and clinically significant challenge in women’s health. It affects approximately 15-24% of women of reproductive age, and accounts for nearly 20% of laparo- scopic procedures and 2-10% of outpatient gynecological consultations. Initial evaluation requires the determi - nation of pregnancy status and careful correlation of symptoms with the clinical examination, both of which are critical for guiding subsequent diagnostic and thera- peutic decisions. Although most causes of acute pelvic pain are non-life- threatening, conditions that endanger life or fertility must be promptly recognized. In 2021, the global incidence of ectopic pregnancy was approximately 213 per 100,000 women. Adnexal torsion accounted for 2.5-7.4% of acute pelvic pain cases, while acute appendicitis remained the most common abdominal surgical emergency, with an incidence of 214 per 100,000 population worldwide(1). Ultrasound has established itself as the first-line im - aging modality in the assessment of acute pelvic pain due to its wide availability, absence of ionizing radia - tion, and ability to rapidly detect both gynecological and nongynecological causes, including intestinal and urogen- ital conditions. In situations where ultrasound is incon- clusive, computed tomography (CT) provides a valuable complementary tool, particularly useful for identifying gastrointestinal and urinary tract pathologies, while magnetic resonance imaging (MRI) may be reserved for selected cases requiring further diagnostic clarification. The etiological spectrum of acute pelvic pain is broad. Gynecological causes involve the uterus, fallopian tubes and ovaries, whereas nongynecological etiologies in - clude intestinal conditions (such as appendicitis and diverticulitis), urological disorders (ureteral or bladder calculi, urinary tract infections) and, less frequently, vascular diseases. In many instances, ultrasound ena - bles the rapid establishment of a precise diagnosis in emergencies that demand prompt medical or surgical intervention, such as ovarian torsion, ectopic pregnancy, or acute appendicitis. Gynecological disorders are among the most frequent etiologies of acute pelvic pain in women of reproductive age. The main causes include ectopic pregnancy, adnexal torsion, ruptured or hemorrhagic ovarian cysts and pel- vic inflammatory disease (PID). Ectopic pregnancy re - mains a critical diagnosis due to the risk of rupture and Table 1 Common radiological findings in acute pelvic pain and suggested differential diagnosis(2) Radiological finding Differential diagnosis Peritoneal fluid Ovarian cyst rupture, ovarian torsion, ovarian hyperstimulating syndrome, ruptured ectopic pregnancy, mittelschmerz, PID, appendicitis, colonic diverticulitis, ovarian carcinoma Fat stranding Ileocecal Appendicitis, Crohn’s disease Pericolic Colonic diverticulitis, epiploic appendagitis, omental infarction Periileal Crohn’s disease, regional enteritis, omental infarction Pelvic PID, endometriosis, iliac aneurysm rupture Perirenal Pyelonephritis Bowel distension Volvulus, incarcerated hernia, intussusception Pneumoperitoneum Intestinal perforation, colonic diverticulitis, appendicitis Retropneumoperitoneum Emphysematous pyelonephritis, perinephric abscess Pelvic mass Gynecological malignancy, degenerated myoma, endometrioma, extrauterine pregnancy, periappendicular abscess, peridiverticular abscess, iliac aneurysm Kidney enlargement Perinephritic abscess, pyelonephritis Retroperitoneal hematoma Aortic/iliac aneurysm rupture, perirenal hematoma 32 Year XIII • No. 50 (4/2025) gynecology maternal morbidity, with an estimated global incidence of 342.44 per 100,000 women. Adnexal torsion accounts for 2.5-7.4% of cases of acute pelvic pain, and requires prompt surgical intervention to preserve ovarian func - tion. Ruptured or hemorrhagic cysts typically cause sud- den, unilateral pelvic pain, sometimes accompanied by mild intraperitoneal bleeding. PID, most often due to ascending bacterial infection, leads to bilateral pain, fever and cervical tenderness, with potential long-term consequences such as infertility (3). Ultrasound plays a central role in the rapid identifica- tion of these conditions, allowing distinction between gynecological and nongynecological causes, and guiding the appropriate management. Surgical pathologies represent an important subset of acute pelvic pain and often require prompt intervention. Acute appendicitis is the most frequent, presenting with right lower quadrant pain, nausea, vomiting and low- grade fever; delayed diagnosis may lead to perforation or peritonitis. Diverticulitis can mimic gynecological pain, causing lower abdominal discomfort, fever and altered bowel habits, occasionally requiring surgical management for complications. Intestinal obstruction, due to adhesions, hernia or volvulus, presents with dif - fuse abdominal pain, distension and vomiting, and may progress to ischemia or perforation if untreated. Ultrasound serves as a first-line imaging modality, aiding in the rapid detection of appendiceal inflamma - tion, bowel wall thickening, fluid collections and other surgical abnormalities, thereby supporting early diag - nosis and timely management. Urological disorders represent an important compo - nent of the differential diagnosis of acute pelvic pain. The most frequent causes include urolithiasis and uri - nary tract infections (UTIs). Urolithiasis, particularly ureteral calculi, is a frequent cause of acute pelvic pain, with global incidence estimates ranging from 114 to over 700 cases per 100,000 population, according to recent multinational epidemiological data. UTIs afflict up to 30-40% of women of reproductive age, presenting with suprapubic pain, dysuria and urinary frequency. Less fre- quent etiologies include interstitial cystitis and urinary retention. Ultrasound remains the first-line imaging modality, allowing the rapid detection of hydronephro - sis, bladder wall changes and intraluminal calculi (4). Therefore, ultrasound remains a cornerstone in the differential diagnosis of gynecological versus surgical causes of acute pelvic pain, supporting the timely iden - tification of patients requiring urgent intervention and guiding optimal clinical management. Aim of the study The aim of this study is to analyze the challenges of differential diagnosis between gynecological and surgi - cal pathologies in patients presenting with acute pelvic pain and to highlight the role of ultrasound as a first- line tool in the rapid identification of underlying causes, thereby facilitating appropriate therapeutic decision- making and optimizing clinical management.

and method The study was conducted through an analysis of the specialized literature on acute pelvic pain and the role of ultrasound in the differential diagnosis between gyneco- logical and surgical pathology. Articles published between 2000 and 2025 were included, accessed from international databases such as PubMed, Scopus and Web of Science, using search terms such as “acute pelvic pain”, “gyneco- logical causes”, “surgical causes”, “urological causes”, “ul- trasound”, “differential diagnosis” and “imaging.” A total of 14 relevant studies were selected, including reviews, international guidelines, clinical and observa - tional studies, addressing the frequency, etiology and management of acute pelvic pain, with a focus on the usefulness of ultrasound in the early diagnosis of con - ditions requiring prompt intervention, such as ovarian torsion, ectopic pregnancy, or acute appendicitis. For each included study, demographic parameters, type of imaging investigations used, diagnostic accuracy of ultrasound, intervention times and clinical outcomes were analyzed. The data were synthesized descriptively and comparatively, highlighting the role of ultrasound as a first-line method and its limitations in the context of the differential diagnosis between gynecological and surgical pathology.

The analysis of the 14 included studies, presented in Table 2, demonstrated that ultrasound represents the first-line imaging method in the evaluation of acute pelvic pain, due to its high accessibility, absence of ion - izing radiation and ability to rapidly provide essential clinical information for therapeutic decision-making. According to the data summarized in Table 3, the sensi- tivity of ultrasound ranged between 80% and 92%, while specificity ranged between 85% and 95%. These values were influenced by the type of pathology investigated, the imaging technique used (transabdominal or trans - vaginal) and the operator’s experience. According to Table 3, ultrasound demonstrates par - ticularly high diagnostic accuracy for gynecological emergencies such as ovarian torsion, ectopic pregnancy and ruptured ovarian cysts. Prompt identification of these conditions facilitates timely surgical or medical management, thereby reducing the risk of severe com - plications, including ovarian loss or life-threatening hemorrhage. Additionally, ultrasound provides valuable clinical information in the assessment of other acute gynecological conditions, including pelvic inflammatory disease, ovarian hematoma and intrauterine bleeding, supporting informed therapeutic decision-making. In nongynecological pathologies, ultrasound has shown diagnostic utility in acute appendicitis, ureteral lithiasis, and urinary tract infections. Nevertheless, its accuracy may be affected by patient-related factors such as body habitus, anatomical variations, or the clinical setting, as well as by operator expertise. In diagnostical- ly inconclusive cases, or when complex intestinal pathol- ogy is suspected, complementary imaging modalities 33 ginecologia Year XIII • No. 50 (4/2025) such as computed tomography or magnetic resonance imaging are recommended. These modalities enhance both sensitivity and specificity, and play a pivotal role in guiding appropriate therapeutic strategies. International guidelines and systematic reviews con- sistently highlight that a multimodal imaging approach – integrating ultrasound with CT or MRI – optimizes diagnostic accuracy, minimizes delays in diagnosis and reduces the incidence of complications, including the need for unplanned surgical interventions. Across all reviewed studies, ultrasound was consist - ently recognized for its rapid applicability, widespread availability in emergency and gynecological settings, and the absence of ionizing radiation. These advantages rein- force its central role as the primary imaging modality in the differential diagnosis of acute pelvic pain, enabling prompt recognition of urgent cases and contributing to improved clinical outcomes and optimized patient management.

The analysis of the specialized literature and the in - tegration of data from Table 4 emphasize the essential role of ultrasound in the differential diagnosis of acute pelvic pain, both for gynecological and for surgical or gastrointestinal pathology. Ultrasound remains the first-line imaging modality owing to its accessibility, absence of ionizing radiation and rapid provision of clini- cally relevant information, thereby facilitating prompt therapeutic decision-making. In the case of ovarian tumors and cysts, the use of IOTA (International Ovarian Tumor Analysis, 2016) Table 2 Studies included in the analysis of the role of ultrasound in the diagnosis of acute pelvic pain No Author(s), year Study type Aim/objective 1 Franco et al., 2023(6) Review Analyzes common gynecological causes of acute pelvic pain, including pelvic inflammatory disease, ruptured ovarian cysts and ovarian torsion. 2 Kruszka and Boulanger, 2010(7) Clinical article Evaluation of acute pelvic pain in women, including pelvic inflammatory disease, ruptured ovarian cysts and appendicitis. 3 Gopireddy et al., 2022(8) Illustrated review Analysis of the use of MRI imaging in the evaluation of acute pelvic pain, particularly of gynecological origin. 4 Brook et al., 2024(9) Guideline Appropriateness criteria for imaging in acute pelvic pain in women of reproductive age. 5 Domínguez et al., 2017(10) Clinical article Gynecological pelvic pain as an emergency condition: functional cysts, ectopic pregnancy, pelvic inflammatory disease, ovarian torsion. 6 Basta Nikolic et al., 2021(11) Review The role of imaging in the evaluation of acute pelvic pain, emphasizing the importance of ultrasound as the first-line method. 7 Henrichsen et al., 2021(12) Guideline Appropriateness criteria for imaging in acute pelvic pain in postmenopausal women. 8 Potter et al., 2008(13) Comparative study Comparison of ultrasound and CT use in the evaluation of acute pelvic pain of gynecological origin. 9 Kaakaji et al., 2000(14) Clinical article The use of ultrasound in obstetric and gynecological emergencies, including acute pelvic pain. 10 Pacione, 2023(15) Review Analysis of different imaging modalities in the non-pregnant female pelvis, including ultrasound, CT and MRI. 11 Dewey and Wittrock, 2019(16) Clinical article Evaluation of acute pelvic pain, including gynecological and nongynecological causes, and the role of imaging. 12 Frasca et al., 2023(17) Clinical study Evaluation of acute pelvic pain in women, discussing common causes and the importance of imaging. 13 Luntsi, 2015(18) Retrospective study Analysis of common gynecological ultrasound patterns in women with pelvic pain in a tertiary hospital in Nigeria. 14 Shebl et al., 2017(19) Narrative review Discusses bladder pain syndrome (BPS) presenting with pain, dysuria, urgency – important in differential diagnosis of pelvic pain. 34 Year XIII • No. 50 (4/2025) gynecology cri teria allows morphological characterization of ad - nexal lesions (simple, hemorrhagic, or complex cysts) and application of the ADNEX model, offering a clear distinction between benign and malignant lesions, and reducing diagnostic errors (20). For deep infiltrating endometriosis (DIE), the IDEA consensus (2016) and the #Enzian classification (2021) provide a systematic ultrasonographic evaluation of pelvic compartments, including the pouch of Douglas, uterosacral ligaments and bowel wall, thereby standardizing terminology and facilitating correlation with laparoscopic findings (21,22). In ectopic pregnancy, the Barnhart classification (2013) establishes standardized ultrasonographic cri - teria for visible gestational sac, nonspecific adnexal mass and pregnancy of unknown location (PUL), optimiz - ing correlation with hCG values and supporting timely clinical decision-making (23). For acute appendicitis, the Rettenbacher classification (2002) defines specific ultra- sonographic parameters, such as appendiceal diameter above 6 mm, non-compressibility, and the presence of complications (abscess, perforation), thereby facilitating the differential diagnosis between gynecological and nongynecological causes of acute pelvic pain (24). In colonic pathology and diverticulitis, local ultra - sonographic classifications (Mizuki et al., 2018) enable the identification of intestinal wall thickening above 5 mm, loss of stratification and pericolic inflammation, contributing to differentiation from endometriosis or pelvic masses (25). These consensuses and classifica - tions demonstrate that the integration of standardized ultrasonographic approaches enhances diagnostic accu- racy and allows clearer communication between radiolo- gists and clinicians. Overall, the reviewed studies confirm that when ul - trasound is applied in accordance with international protocols and consensuses, it optimizes the differential diagnosis, reduces the risk of complications, and limits the need for additional imaging investigations. This has a direct impact on the management of patients present- ing with acute pelvic pain.

Ultrasound is confirmed as the first-line imaging modality in the evaluation of acute pelvic pain, owing to its rapidity, accessibility and absence of ionizing radia- tion, providing essential clinical information for timely therapeutic decision-making. Sensitivity and specificity values, ranging from 80-92% and 85-95%, respectively, demonstrate the accuracy of ultrasound in diagnosing major gynecological causes, including ovarian torsion, ectopic pregnancy and ruptured ovarian cysts. For nongynecological pathologies, ultrasound re - mains useful; however, computed tomography and magnetic resonance imaging are recommended in in - conclusive cases or when patient anatomy is complex, highlighting the importance of a multimodal imaging approach. The application of standardized ultrasono - graphic consensuses and classifications – including IOTA, IDEA, #Enzian, Barnhart, Rettenbacher, and Mizuki et al. – enhances diagnostic accuracy, facilitates Cause Imaging method Sensitivity (%) Specificity (%) Observations Ovarian torsion Transvaginal ultrasound 92 95 Enables rapid diagnosis and urgent surgical intervention. Ectopic pregnancy Transvaginal ultrasound 90 94 Early detection reduces the risk of hemorrhagic complications. Ruptured ovarian cyst Ultrasound 88 90 Identifies most cases with clear ultrasonographic signs. Pelvic inflammatory disease Ultrasound 85 88 Allows identification of collections or pelvic inflammation. Acute appendicitis Ultrasound 85 88 CT improves accuracy in inconclusive cases. Ureteral lithiasis Ultrasound 82 89 CT detects small ureteral stones or complex situations. Urinary tract infections/hydronephrosis Ultrasound 80 85 Ultrasound highlights dilatation or renal changes. Complex nongynecological causes Ultrasound + CT/MRI 90-95 96-99 A multimodal approach optimizes diagnostic accuracy and guides therapy. Table 3 Sensitivity and specificity of ultrasound and other imaging methods in various causes of acute pelvic pain 35 ginecologia Year XIII • No. 50 (4/2025) communication between clinicians and radiologists, and allows the precise correlation with surgical or laparo - scopic findings. Furthermore, ongoing operator training and adher - ence to standardized protocols are essential for optimiz- ing ultrasound performance and minimizing diagnostic errors. Overall, ultrasound, integrated with clinical data and, when appropriate, complementary imaging, consti- tutes the primary tool in the management of patients with acute pelvic pain, providing an effective differential diagnosis and contributing to the prevention of compli- cations. n Table 4 Ultrasonographic classifications and consensuses used in the evaluation of acute pelvic pathologies and their clinical utility Pathology Classification/consensus Year/group Ultrasonographic features described Clinical utility Ovarian tumors/cysts IOTA (International Ovarian Tumor Analysis)(15) 2016 Morphology of adnexal lesions (simple, hemorrhagic, complex cysts), simple rules, ADNEX score Differentiation between benign and malignant lesions; reduction of diagnostic errors Deep infiltrating endometriosis (DIE) IDEA consensus (International Deep Endometriosis Analysis)(16) 2016 Uterus, ovaries, pouch of Douglas, rectovaginal septum, bowel wall, sliding sign Standardized terminology for ultrasound reporting #Enzian Classification (echography)(17) 2021 Pelvic compartments (A – vaginal/rectovaginal, B – uterosacral ligaments, C – rectum), extent of DIE Uniform description of lesion extent and correlation with laparoscopic findings Ectopic pregnancy Barnhart Classification (18) 2013 Visible gestational sac, nonspecific adnexal mass, pregnancy of unknown location (PUL) Standardization of ultrasonographic diagnosis and correlation with hCG values Acute appendicitis Rettenbacher Classification (19) 2002 Normal appendix, early appendicitis (>6 mm, non-compressible), complicated appendicitis (abscess, perforation) Ultrasonographic differential diagnosis in acute pelvic pain Diverticulitis/colonic pathology Local ultrasonographic classifications (Mizuki et al.)(25) 2005 Grade I: inflamed diverticulum with pericolic inflammation and an abscess ≤2 cm. Grade II: abscess >2 cm and/or pneumoperitoneum Differentiation from endometriosis or pelvic masses Urolithiasis/ obstructive uropathy UTD (Urinary Tract Dilation) Classification (prenatal/ postnatal) & standard grading of hydronephrosis/stone-related obstruction (24) 2014 (UTD consensus) & various subsequent updates Renal pelvis AP diameter, calyceal dilation, ureteral dilation, parenchymal changes, bladder abnormalities Comprehensive evaluation of urinary tract obstruction; aids in correlating ultrasound findings with clinical symptoms in pelvic pain and planning further interventions 1. Wei N, Peng L, Chen Y, Wang B, Yang J. Global and China burden of ectopic pregnancy (1990-2021): Trends, patterns, and future projections. J Obstet Gynaecol Res. 2025;51(7):e70005. 2. Nikolic MB, Spasic A, Simonji DH, Stojanović S, Nikolic O, Nikolic D. Imaging of acute pelvic pain, Brit J Radiol. 2021;94(1127):20210281. 3. He D, Wang T, Ren W. Global burden of pelvic inflammatory disease and ectopic pregnancy from 1990 to 2019. BMC Public Health. 2023;23(1):1894. 4. Yao W, Wei X, Jing Q, Yuan X, Liu F, Zhang X. Epidemiological trends of urolithiasis in working-age populations: Findings from the global burden of disease study 1990-2021. PLoS One. 2025;20(7):e0327343. 5. Shetty MK. Acute pelvic pain: role of imaging in the diagnosis and management. Semin Ultrasound, CT MR. 2023;44(6):491-500. 6. Franco PN, García-Baizán A, Aymerich M, Maino C, Frade-Santos S, Ippolito D, Otero-García M. Gynaecological causes of acute pelvic pain: common and not- so-common imaging findings. Life (Basel). 2023;13(10):2025. 7. Kruszka PS, Boulanger BR. Evaluation of acute pelvic pain in women. Am Fam Physician. 2010;82(6):614-22. 8. Gopireddy DR, Virarkar M, Kumar S, Vulasala SSR, Nwachukwu C, Lamsal S. Acute pelvic pain: A pictorial review with magnetic resonance imaging. J Clin Imaging Sci. 2022;12:48. 9. Expert Panel on GYN and OB Imaging, Brook OR, Dadour JR, et al. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: 2023 Update. J Am Coll Radiol. 2024;21(6S):S3-S20. 10. Domínguez F, Mora Jurado A, García de la Oliva A, de Araujo Martins-Romeo D,

36 Year XIII • No. 50 (4/2025) Abonații la revista Viața Medicală p rimesc:  5 EMC - membrii Colegiului Medicilor Stomatologi din România  10 EFC - membrii Colegiului Farmaci/uni0219tilor din România  5 EMC - membrii OAMGMAMR  7 FPC - membrii OBBCSSR B e n e fic i e z i d e o f e rta s pecială : 1 2 v o lum e d e s pecia l ita t e g r a t uit e , î n f o r m a t d i g i t a l ! P R O FITA/uni021AI d e r e d u c e r e p ân ă l a 31 d e c e m brie 2 02 5 Abonamente Combo* formate din revista Viața Medicală o revistă la alegere dintre: Medic.ro, Farmacist.ro, Psihiatru.ro, ORL.ro, Pediatru.ro, Ginecologia.ro, Oncolog- Hematolog.ro, Alergologia, The Romanian Journal of Nutrition. *Abonamentele Combo oferă 10 EMC pentru medici, credite suplimentare pentru farmaci/uni0219ti, asisten/uni021Bi /uni0219i moa/uni0219e /uni0219i EMCD pentru dieteticieni Combo t ipărit 399 lei până l a 3 1 dec 2 025 359 lei Combo PDF 259 lei până l a 3 1 dec 2 025 220 lei Abonament revistă tipărită 4 ed i/uni021Bi i t i păr i t e & P DF + 2 ed i/uni021Bi i elec t r oni c e 200 lei » P r e /uni021B redu s p ână l a 3 1 dec. 2 025 160 lei Abonament digital 6 ed i/uni021Bi i P DF / a n 120 lei » P r e /uni021B redu s p ână l a 3 1 dec. 2 025 100 lei www.viata-medicala.ro/abonamente Revistă de opinie și informare a breslei medicale din România gynecology Cueto Álvarez L. Gynecological pelvic pain as emergency pathology. Radiologia. 2017;59(2):115 -27. 11. Basta Nikolic M, Spasic A, Hadnadjev Simonji D, Stojanović S, Nikolic O, Nikolic D. Imaging of acute pelvic pain. Br J Radiol. 2021;94(1127):20210281. 12. Expert Panel on GYN and OB Imaging, Henrichsen TL, Maturen KE, et al. ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain. J Am Coll Radiol. 2021;18(5S):S119-S125. 13. Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 2008;28(6):1645-1659. 14. Kaakaji Y, Nghiem HV, Nodell C, Winter TC. Sonography of obstetric and gynecologic emergencies: Part II, Gynecologic emergencies. AJR Am J Roentgenol. 2000;174(3):651-656. 15. Pacione L. The acute female nongravid pelvis: a review of appropriate clinical applications of Sonography, Computed Tomography, and Magnetic Resonance Imaging. J Diag Med Sonograph. 2023;39(3):282-7. 16. Dewey K, Wittrock C. Acute pelvic pain. Emerg Med Clin North Am. 2019;37(2):207-18. 17. Frasca DJ, Jarrio CE, Perdue J. Evaluation of Acute Pelvic Pain in Women. Am Fam Physician. 2023;108(2):175-180. 18. Luntsi G. Pattern of Gynaecological Pelvic Ultrasound Findings among Women with Pelvic Pain in a Tertiary Hospital in Kano, North Western Nigeria. J Dental Med Sci. 2015;14(7):79-82 19. Shebl SE, Dawood AS, Dawood AGS. Bladder pain syndrome from urogynecological point of view: a narrative. Int J Reprod, Contracept, Obstet Gynecol. 2017;6(5):1694–702. 20. Cherukuri S, Jajoo S, Dewani D. The International Ovarian Tumor Analysis- Assessment of Different Neoplasias in the Adnexa (IOTA-ADNEX) Model Assessment for Risk of Ovarian Malignancy in Adnexal Masses. Cureus. 2022;14(11):e3119 4. 21. Indrielle-Kelly T, Frühauf F, Fanta M, Burgetova A, Lavu D, Dundr P, Cibula D, Fischerova D. Application of International Deep Endometriosis Analysis (IDEA) group consensus in preoperative ultrasound and magnetic resonance imaging of deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2020;56(1):115-6. 22. Keckstein J, Hudelist G. Classification of deep endometriosis (DE) including bowel endometriosis: From r-ASRM to #Enzian-classification. Best Pract Res Clin Obstet Gynaecol. 2021;71:27-37. 23. Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361(4):379- 87. 24. Hoffmann JC, Trimborn CP, Hoffmann M, Schröder R, Förster S, Dirks K, Tannapfel A, Anthuber M, Hollerweger A. Classification of acute appendicitis (CAA): treatment directed new classification based on imaging (ultrasound, computed tomography) and pathology. Int J Colorectal Dis. 2021;36(11):2347-60. 25. Mizuki A, Kaneda S, Tatemichi M, Nakazawa A, Tsukada N, Nagata H, Kanai T. Validation by CT of the new ultrasonography classification of acute colonic diverticulitis among Japanese patients. Cogent Medicine. 2018;5(1):1507478.

This work is permanently accessible online free of charge and published under the CC-BY. CONFLICT OF INTERESTS: none declared. FINANCIAL SUPPORT: none declared.