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

Background. Acute pelvic pain is a frequent clinical emer­gency, with an incidence of 15-24% among women, and may result from both gynecological and surgical cau­ses. Differentiating between these conditions remains a di­ag­nos­tic challenge, as rapid and accurate identification of the underlying pathology is essential for timely in­ter­ven­tion. Objective. This study aims to analyze the role of ul­tra­sound in the differential diagnosis of acute pelvic pain, em­pha­si­zing its accuracy, limitations and integration with com­ple­men­tary imaging methods. Materials and method. A sys­te­ma­tic literature review was conducted, in­clu­ding 13 cli­ni­cal studies, reviews and international guide­lines pu­blished between 2000 and 2025, identified in PubMed, Sco­pus and Web of Science. The search used key­words such as “acute pelvic pain”, “gynecological causes”, “sur­gi­cal causes”, “ultrasound” and “differential diagnosis”. Data ex­trac­ted included diagnostic accuracy, clinical ap­pli­ca­bi­li­ty and com­pa­rative imaging findings. Results. Ul­tra­sound emerged as the first-line imaging method in acute pelvic pain eva­lua­tion due to its accessibility, lack of io­ni­zing ra­dia­tion and the ability to provide rapid diagnostic in­for­ma­tion. The reported sensitivity ranged between 80% and 92%, and spe­ci­fi­city ranged between 85% and 95%, de­pen­ding on path­o­logy and operator expertise. Ultrasound de­mon­stra­ted high accuracy in diagnosing ovarian torsion, ec­to­pic preg­nancy and ruptured ovarian cysts, while CT and MRI proved ne­ces­sary in inconclusive cases or in suspected gas­tro­in­tes­ti­nal and urological conditions. Standardized clas­si­fi­ca­tions and consensuses (IOTA, IDEA, #Enzian, Barnhart, Rettenbacher, Mizuki et al.) enhanced diagnostic con­sis­tency and clinical decision-making. Conclusions. Ul­tra­sound remains the cornerstone in the evaluation of acute pelvic pain, ef­fec­tively guiding the differential diag­no­sis between gyne­­co­lo­gi­cal and surgical conditions. Its in­te­gra­tion with cli­­ni­­cal data and, when necessary, with CT or MRI en­sures op­ti­mal pa­tient management, minimizes diagnostic er­rors, and re­duces the risk of complications.