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Is There Any Benefit to Obtaining a Pelvic Ultrasound After a Negative CT of the Abdomen/Pelvis in a Woman with Chronic Abdominal Pain?

  • Janet Smereck
  • Kerri Layman
Chapter

Abstract

The adult female patient with chronic pelvic pain, defined as noncyclic pain of greater than 6 months’ duration, presents unique diagnostic challenges. Etiology may be gynecologic, gastrointestinal, urologic, or neuropathic in origin. CT (computerized tomography) is frequently performed in the evaluation of pelvic pain, but may not be the ideal investigative modality, and important findings may be missed. Pelvic ultrasonography often yields important diagnoses in the woman with chronic pelvic pain. Endometriosis, uterine leiomyomatosis and adenomyosis, pelvic congestion syndrome, and polycystic ovary syndrome are conditions diagnosed in a significant proportion of patients with chronic pelvic pain; chronic ovarian torsion is a rare but critical entity to consider.

Keywords

Chronic pelvic pain Ultrasonography Duplex ultrasound 

References

  1. 1.
    Vercellini P, Somigliana E, Vigano P, Abbiati A, Barbara G, Fedele L. Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach. Gynecol Endocrinol. 2009;25(3):149–58.CrossRefGoogle Scholar
  2. 2.
    Speer L, Mushkbar S, Erbele T. Chronic pelvic pain in women. Am Fam Physician. 2016;93(5):380–7.PubMedGoogle Scholar
  3. 3.
    Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol. 2013;64(3):431–9.CrossRefGoogle Scholar
  4. 4.
    Stein SL. Chronic pelvic pain. Gastroenterol Clin N Am. 2013;42(4):785–800.CrossRefGoogle Scholar
  5. 5.
    Reiter RC. Occult somatic pathology in women with chronic pelvic pain. Clin Obstet Gynecol. 1990;33(1):154–60.CrossRefGoogle Scholar
  6. 6.
    Zackowski S. Chronic recurrent abdominal pain. Emerg Med Clin North Am. 1998;16(4):877–94.CrossRefGoogle Scholar
  7. 7.
    Latthe P, Latthe MC, Say L, Gulmezoglu M, Khan KS. WHO systemic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;6:177.CrossRefGoogle Scholar
  8. 8.
    Ahangari A. Prevalence of chronic pelvic pain among women: and updated review. Pain Physician. 2014;17(2):E141–7.PubMedGoogle Scholar
  9. 9.
    Ferrero S, Ragni N, Remorgida V. Deep dyspareunia: causes, treatments, and results. Curr Opin Obstet Gynecol. 2008;20(4):394–9.CrossRefGoogle Scholar
  10. 10.
    Parazzini F, Mais V, Cipriani S, Busacca M, Venturini P. GISE. Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur J Obstet Gynecol Reprod Biol. 2009;143(2):103–6.CrossRefGoogle Scholar
  11. 11.
    Mui J, Allaire C, Williams C, Yong PJ. Abdominal wall pain in women with chronic pelvic pain. J Obstet Gynaecol Can. 2016;38(2):154–9.CrossRefGoogle Scholar
  12. 12.
    Farley M, Patsalides B. Physical symptoms, posttraumatic stress disorder, and healthcare utilization of women with and without childhood physical and sexual abuse. Psychol Rep. 2002;89:595–606.CrossRefGoogle Scholar
  13. 13.
    Amirbekian S, Hooley R. Ultrasound evaluation of pelvic pain. Radiol Clin North Am. 2014;52(6):1215–35.CrossRefGoogle Scholar
  14. 14.
    Juhan V. Chronic pelvic pain: an imaging approach. Diagn Interv Imaging. 2015;96(10):997–1007.CrossRefGoogle Scholar
  15. 15.
    Khatri G, Khan A, Raval G, Chhabra A. Diagnostic evaluation of chronic pelvic pain. Phys Med Rehabil Clin N Am. 2017;28(3):477–500.CrossRefGoogle Scholar
  16. 16.
    Benjamin-Pratt AR, Howard FM. Management of chronic pelvic pain. Minerva Ginecol. 2010;62(5):447–65.PubMedGoogle Scholar
  17. 17.
    Liddle AD, Davies AH. Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology. 2007;22(3):100–4.CrossRefGoogle Scholar
  18. 18.
    Rane N, Leyon JJ, Littlehales T, Ganeshan A, Crowe P, Uberoi R. Pelvic congestion syndrome. Curr Probl Diagn Radiol. 2013;42(4):135–40.CrossRefGoogle Scholar
  19. 19.
    Ganeshan A, Upponi S, Hon L, Uthappa MC, Warakaulle DR, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 2007;30(6):1105–11.CrossRefGoogle Scholar
  20. 20.
    Ssi-Yan G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, et al. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25(1):51–9.CrossRefGoogle Scholar
  21. 21.
    Lourenco A, Swenson D, Tubbs R, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT and MRI. Emerg Radiol. 2014;21(2):179–87.CrossRefGoogle Scholar
  22. 22.
    Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 2004;23(12):1643–9.CrossRefGoogle Scholar
  23. 23.
    Sohoni A, Bosley J, Miss JC. Bedside ultrasonography for obstetric and gynecologic emergencies. Crit Care Clin. 2014;30(2):207–26.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Janet Smereck
    • 1
  • Kerri Layman
    • 2
  1. 1.Department of Emergency MedicineMedStar Georgetown University HospitalWashington, DCUSA
  2. 2.Department of Emergency MedicineMedStar Washington Hospital Center & MedStar Georgetown University HospitalWashington, DCUSA

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