Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond.

TitleImaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond.
Publication TypeJournal Article
Year of Publication2017
AuthorsNaffaa, L., Deshmukh T., Tumu S., Johnson C., Boyd K. P., & Meyers A. B.
JournalCurrent problems in diagnostic radiology
Volume46
Issue4
Pagination317-329
Date Published2017 Jul - Aug
ISSN1535-6302
KeywordsAcute Disease; Adolescent; Child; Child, Preschool; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Infant; Pain Measurement; Pelvic Pain
Abstract

Identifying the etiology of acute pelvic pain in girls is often clinically challenging. Particularly in young girls, it is often difficult to determine if acute pelvic symptoms are originating from a gynecologic source or from a genitourinary or gastrointestinal etiology based on the child's clinical examination alone. Therefore, imaging plays a key role in establishing a diagnosis and in directing medical and surgical treatment. Pediatric gynecologic conditions, which can present acutely with pain or mass or both include ovarian torsion, hematometrocolpos, pelvic inflammatory disease, inguinal hernias containing an ovary or the uterus or both, adnexal cysts, pregnancy, vaginal foreign bodies, and ovarian vein thrombosis. Sources of pelvic pain in girls from nongynecologic etiologies include appendicitis, distal ureterolithiasis, and Crohn's disease. Owing to the lack of ionizing radiation, widespread availability, and lack of need for sedation, gray scale, with color Doppler ultrasound examination is often the initial imaging obtained when there is suspicion of gynecologic pathology. Radiographs of the abdomen and pelvis are commonly used in the acute setting, when there is concern for a bowel obstruction or free intraperitoneal air. Cross-sectional imaging with computed tomography or magnetic resonance imaging is used, when the diagnosis remains unknown and to clarify findings found on ultrasound and radiographs. Correctly identifying and diagnosing the causes of acute pelvic pain in girls is crucial for the care of these patients. Here, we review the spectrum of causes of acute pelvic pain in female infants to teens with emphasis on imaging approach and age-related characteristics. OBJECTIVES:

DOI10.1067/j.cpradiol.2016.12.010
Alternate JournalCurr Probl Diagn Radiol