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KEY TERMS

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Key Terms

  1. Torsion: twisting of an organ usually associated with vascular compromise.

  2. Acute versus chronic pelvic pain: acute usually implies within 1-2 weeks of initial episode, chronic greater than for 2 weeks or so.

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OVERVIEW

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One of the most frequent patient reports encountered by a gynecologist is pelvic pain, either acute (hours duration) or chronic (weeks, months, years duration). Transvaginal sonography (TVS) alone and with color Doppler sonography (CDS) is an effective means to detect the location and source of pelvic pain. Imaging is most helpful when there is a structural, as opposed to functional, cause of pelvic pain such as an ovarian cyst, fibroid, or congested pelvic vasculature.

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There are many causes of pelvic pain, some of which can be detected with imaging techniques; in other cases, the cause of pain remains uncertain even after laparoscopy. One of the most common causes of acute and/or recurrent pelvic pain is associated with hemorrhage into functional ovarian cysts or endometriomas. In one study, only 63% of women undergoing laparoscopy for pelvic pain had abnormal findings using direct inspection.1 Conversely, 18% of women with pain and abnormal pelvic examinations had no abnormalities at laparoscopy. In this correlative study of women with pelvic pain who underwent laparoscopy, ovarian abnormalities accounted for approximately 10%, 27% had pelvic adhesions, 22% had pelvic inflammatory disease, and 3% had unsuspected endometriomas. Thus, functional or dynamic disorders may be the cause of pelvic pain; there is not always correlation between the presence of pelvic pain and an anatomic abnormality of the pelvic organs.

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Patients with acute pelvic pain most often present in an emergency department setting. Because several causes of acute pain can be life-threatening (eg, ectopic pregnancy, hemorrhagic cyst), prompt diagnosis is critical. Part of this diagnosis is dependent on accurate imaging assessment. Additionally, TVS and/or transabdominal sonography (TAS) have a pivotal role in distinguishing gynecologic from nongynecologic causes such as appendicitis or distal ureteral obstruction due to a renal calculus.2

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Chronic pelvic pain is defined as intermittent or constant pain in the pelvic region of at least 6 months’ duration that does not occur exclusively with menstruation or intercourse and not accounted for by a pregnancy-related condition. It is conceptually important to realize that chronic pelvic pain is a symptom and not a diagnostic entity. This is because it can be the result of gynecologic or nongynecologic conditions, such as fibromyalgia, adhesions, and ischemic and/or inflamed bowel. Globally, patients with chronic pelvic pain present to the primary care health worker as frequently as that of migraine or low back pain.

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As is true for acute pelvic pain, TVS has an important role in the assessment of the gynecologic and nongynecologic organs in the pelvis in patients with chronic pelvic pain, but it is best suited to diagnose gynecologic-related disorders. Those disorders associated with acute and/or chronic ...

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