ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain

Expert Panel on GYN and OB Imaging, Tara L. Henrichsen, Henrichsen TL, Katherine E. Maturen, Robbins JB, Jessica B. Robbins, Esma A Akin, Akin EA, Susan M. Ascher, Ascher SM, Olga R. Brook, Mark Dassel, Dassel M, Lucas Friedman, Friedman L, Lee A. Learman, Learman LA, Michael N. Patlas, Patlas MN, Sadowski EA, Elizabeth A. Sadowski, Carl J. Saphier, Carl Saphier, Saphier C, Ashish P. Wasnik, Phyllis Glanc, Glanc P
Journal of the American College of Radiology : JACR · 2021 · vol. 18(5) , pp. S119–S125 · doi:10.1016/j.jacr.2021.02.003 · PMID:33958106 · W3158274087
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This paper provides evidence-based guidelines for selecting the most appropriate imaging modality for postmenopausal women presenting with acute pelvic pain, considering gynecologic and other system etiologies.

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Abstract

Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm. Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems. As the optimal imaging modality varies for these etiologies, it is important to narrow the differential diagnosis before choosing the initial diagnostic imaging examination. Transabdominal and transvaginal ultrasound are the best initial imaging techniques when the differential is primarily of gynecologic origin. CT with intravenous (IV) contrast is more useful if the differential diagnosis remains broad. MRI without IV contrast or MRI without and with IV contrast, as well as CT without IV contrast may also be used for certain differential considerations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Condition tags

chronic_pelvic_pain

MeSH descriptors

Postmenopause Postmenopause Societies, Medical Societies, Medical Diagnosis, Differential Diagnosis, Differential Evidence-Based Medicine Evidence-Based Medicine Female Female Humans Humans Pelvic Pain Pelvic Pain Pelvic Pain Pelvic Pain Ultrasonography Ultrasonography United States United States

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