Underrecognized Causes of Chronic Female Pelvic Pain - It is not just stress or hormones

Genital / Reproductive system female, Pelvis, Vascular, CT, CT-Angiography, MR, Contrast agent-intravenous, Education, Patterns of Care, Pelvic floor dysfunction, Varices Authors: D. Janjic, T. B. Plojović, I. Vujic, S. Hasanagic, B. Jovandić, D. Vasin DOI: 10.26044/ecr2026/C-15594 Learning objectives After reviewing this educational exhibit, the reader will be able to: Recognize imaging features of less commonly identified causes of chronic pelvic pain (CPP) in women. Identify imaging clues that may explain persistent symptoms in patients without an established diagnosis. Understand common diagnostic pitfalls that contribute to delayed recognition of underlying pathology

Chronic pelvic pain (CPP) is a common and often debilitating complaint in women, accounting for a significant number of outpatient visits and repeated diagnostic evaluations. Despite its prevalence, many patients remain without a clear diagnosis for years.A major challenge lies in the nonspecific nature of symptoms and the frequent absence of obvious findings on initial clinical assessment or first-line imaging. As a result, CPP is often approached as a diagnosis of exclusion, leading to multiple referrals across different specialties before an underlying cause is identified.Imaging... Findings and procedure details Assessment of chronic pelvic pain requires a targeted, multimodality imaging approach driven by symptom patterns and clinical context rather than a purely algorithmic workup.Ultrasound is usually the first-line modality but remains limited in subtle, deep, or extrinsic disease.Computed Tomography (CT) may reveal vascular or inflammatory abnormalities, particularly in non-gynecologic causes, yet lacks sufficient soft-tissue characterization for complex pelvic pathology.Magnetic resonance imaging (MRI) is the gold standard, problem-solving modality, providing superior soft-tissue contrast and a comprehensive evaluation of pelvic organs, vasculature, and deep infiltrating lesions.Accurate diagnosis...

Chronic pelvic pain in women often reflects an underlying structural or vascular abnormality that may remain unrecognized without focused imaging assessment.Accurate diagnosis relies on correlation of imaging findings with clinical presentation. Increased awareness of less commonly recognized entities may reduce diagnostic delay and support more appropriate patient management, ultimately improving care for women affected by this increasingly prevalent condition. Personal information and conflict of interest D. Janjic: Nothing to disclose T. B. Plojović: Nothing to disclose I. Vujic: Nothing to disclose S. Hasanagic: Nothing to disclose B. Jovandić: Nothing to disclose D. Vasin: Nothing to disclose

Machan L, Durham J. Pelvic congestion syndrome. Semin Intervent Radiol. 2013;30(4):372-380. doi:10.1055/s-0033-1359731Onka B, Khouchoua S, Romeo T, et al. Nutcracker syndrome: a rare cause of chronic pelvic pain and left back pain. Radiol Case Rep. 2021;16(8):2025-2030. doi:10.1016/j.radcr.2021.05.007Chen Q, Li YW, Wang S, et al. Clinical manifestations of adenomyosis patients with or without pain symptoms. J Pain Res. 2019;12:3127-3133. doi:10.2147/JPR.S212117Natkanska A, Bizon-Szpernalowska MA, Milek T, Sawicki W. Peritoneal inclusion cysts as a diagnostic and treatment challenge. Ginekol Pol. 2021;92(8):583-586. doi:10.5603/GP.a2021.0142Dai Y, Leng JH, Lang JH, Li...