Imaging of Acute Pelvic Pain in Women

Emergency, Genital / Reproductive system female, Pelvis, CT, MR, Ultrasound, Comparative studies, Acute, Infection, Inflammation Authors: J. P. Santos, A. Guerra DOI: 10.26044/ecr2026/C-10826 Learning objectives The objective of this work is to review the major gynecologic, urologic, and gastrointestinal causes of acute pelvic pain in women presenting to the emergency department, with particular emphasis on the role of imaging in diagnosis and management. Through an integrated, system-based approach, this review highlights key imaging features, appropriate modality selection, and time-sensitive conditions requiring urgent intervention to reduce morbidity and preserve fertility.

Acute pelvic pain is a frequent and diagnostically challenging complaint among women presenting to the emergency department (ED). Abdominal pain accounts for approximately 5–10% of annual ED visits; however, the true prevalence of pelvic pain is difficult to quantify, as it is rarely analysed separately from generalized abdominal pain in epidemiologic studies. The complexity of pelvic pain arises from its broad differential diagnosis, encompassing gynecologic, urologic, gastrointestinal, and musculoskeletal conditions with overlapping clinical presentations.In women of reproductive age, determination of pregnancy status is the first... Findings and procedure details Diagnostic Imaging ApproachUltrasound is the first-line imaging modality for suspected gynecologic causes of pelvic pain due to its absence of ionizing radiation, wide availability, low cost, and high resolution, particularly with transvaginal ultrasound. Computed tomography (CT) is preferred when non-gynecologic causes are suspected, including appendicitis, diverticulitis, bowel obstruction, or urolithiasis, providing superior evaluation of bowel, urinary tract, and peritoneal structures. If CT demonstrates indeterminate pelvic findings, targeted ultrasound may be used as a complementary examination. Magnetic resonance imaging (MRI) serves as a problem-solving tool in...

Acute pelvic pain in women requires a systematic, multidisciplinary approach. Imaging is central to differentiating gynecologic, urologic, and gastrointestinal causes. Ultrasound remains the cornerstone of gynecologic evaluation, CT is essential for non-gynecologic emergencies, and MRI provides valuable problem-solving capabilities. Early diagnosis is crucial to guide management and prevent serious complications. Personal information and conflict of interest J. P. Santos: Nothing to disclose A. Guerra: Nothing to disclose

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