TVUS and TAUS of the pelvis is the most useful imaging modality for initial assessment when an obstetrical or gynecological etiology is suspected [13]. A combined transabdominal and transvaginal approach is typically used for pelvic US imaging. TVUS demonstrated a sensitivity of 83.3% for ovarian torsion, 84% for endometriotic cyst, 88.2% for hemorrhagic cysts, 58.3% for TOA, and 62.5% for dermoid cysts in a prospective study on 74 patients evaluated with TVUS and MRI. Overall sensitivity of TVUS for these pathological entities was 78.4% [26]. For the diagnosis of adnexal torsion with US, a meta-analysis of 12 studies including 1,187 patients reported a pooled sensitivity of 79% and a pooled specificity of 76%, with negative and positive likelihood ratios of 0.29 and 4.35, respectively [22]. Signs of ovarian torsion on US have varying accuracy: the sensitivity and specificity are 21% and 100% for ovarian tissue edema; 52% and 91% for absence of intraovarian vascularity; 76% and 99% for absence of arterial flow; and 100% and 97% for absence or abnormal venous flow [29]. Other signs indicating torsion are a unilaterally enlarged ovary with central afollicular stroma and multiple uniform 8 to 12 mm peripheral follicles (found in up to 74% of cases); ovarian enlargement is defined as a maximal ovarian dimension of >4 cm or volume >20 cm3 in a premenopausal patient. However, up to 5% of torsed ovaries have been reported to be of normal size [21]. PID can be difficult to diagnose because the symptoms are often subtle and mild. In a small prospective study of 52 patients, the detection rate of moderate-to-severe salpingitis with US was 100%, compared with 25% in the case of mild salpingitis. Bilateral adnexal masses were seen 82% of the time in patients with PID versus 17% for those with other diagnoses. The positive likelihood ratio was 4.8, and the negative likelihood ratio was 0.22.
Acute Pelvic Pain in the Reproductive Age Group. TVUS and TAUS of the pelvis is the most useful imaging modality for initial assessment when an obstetrical or gynecological etiology is suspected [13]. A combined transabdominal and transvaginal approach is typically used for pelvic US imaging. TVUS demonstrated a sensitivity of 83.3% for ovarian torsion, 84% for endometriotic cyst, 88.2% for hemorrhagic cysts, 58.3% for TOA, and 62.5% for dermoid cysts in a prospective study on 74 patients evaluated with TVUS and MRI. Overall sensitivity of TVUS for these pathological entities was 78.4% [26]. For the diagnosis of adnexal torsion with US, a meta-analysis of 12 studies including 1,187 patients reported a pooled sensitivity of 79% and a pooled specificity of 76%, with negative and positive likelihood ratios of 0.29 and 4.35, respectively [22]. Signs of ovarian torsion on US have varying accuracy: the sensitivity and specificity are 21% and 100% for ovarian tissue edema; 52% and 91% for absence of intraovarian vascularity; 76% and 99% for absence of arterial flow; and 100% and 97% for absence or abnormal venous flow [29]. Other signs indicating torsion are a unilaterally enlarged ovary with central afollicular stroma and multiple uniform 8 to 12 mm peripheral follicles (found in up to 74% of cases); ovarian enlargement is defined as a maximal ovarian dimension of >4 cm or volume >20 cm3 in a premenopausal patient. However, up to 5% of torsed ovaries have been reported to be of normal size [21]. PID can be difficult to diagnose because the symptoms are often subtle and mild. In a small prospective study of 52 patients, the detection rate of moderate-to-severe salpingitis with US was 100%, compared with 25% in the case of mild salpingitis. Bilateral adnexal masses were seen 82% of the time in patients with PID versus 17% for those with other diagnoses. The positive likelihood ratio was 4.8, and the negative likelihood ratio was 0.22.