CT findings of ovarian torsion include an enlarged, featureless, and hypoenhancing ovary, sometimes with apparent swirling of vascular pedicle and abnormal craniocaudal orientation of ovary or uterine deviation to the affected side [12-16]. Contrast-enhanced CT may be helpful for identification of uterine fibroids that have undergone torsion or necrosis [12,17], with the findings of diminished contrast enhancement of the fibroid(s) (86% sensitivity) and ascites (100% sensitivity) demonstrating the best diagnostic performance in a series of 51 cases [18]. CT is also helpful in evaluation of fibroids when calcified masses cause shadowing and limit visualization of the pelvic contents by US [19]. Contrast-enhanced CT may aid in the early diagnosis of PID with the findings of pelvic fluid, loss of normal fat planes, and/or subtle enhancement of the endocervical canal or fallopian tubes prior to emergence of the dilatation and enlargement that can be identified with US [20,21]. Fulminant PID on CT demonstrates fluid in the endometrial canal, distended and thickened fallopian tubes with wall enhancement, and ovarian enlargement [12,20,22]. CT findings late in the course of PID with formation of a tubo-ovarian abscess includes a complex cystic mass with thick enhancing walls [14,22] and anterior displacement of the mesosalpinx, which helps to distinguish tubo-ovarian abscess from other sources of abscess formation in the pelvis [12,22,23]. MRI Pelvis MRI is most often utilized as a problem-solving examination if US or CT do not reveal an etiology of pain. Potential benefits of MRI in the acute pelvic pain setting are high spatial resolution and excellent soft-tissue contrast. This allows for more precise localization and origin of pathology identified on US and CT [12,24].
Postmenopausal Acute Pelvic Pain. CT findings of ovarian torsion include an enlarged, featureless, and hypoenhancing ovary, sometimes with apparent swirling of vascular pedicle and abnormal craniocaudal orientation of ovary or uterine deviation to the affected side [12-16]. Contrast-enhanced CT may be helpful for identification of uterine fibroids that have undergone torsion or necrosis [12,17], with the findings of diminished contrast enhancement of the fibroid(s) (86% sensitivity) and ascites (100% sensitivity) demonstrating the best diagnostic performance in a series of 51 cases [18]. CT is also helpful in evaluation of fibroids when calcified masses cause shadowing and limit visualization of the pelvic contents by US [19]. Contrast-enhanced CT may aid in the early diagnosis of PID with the findings of pelvic fluid, loss of normal fat planes, and/or subtle enhancement of the endocervical canal or fallopian tubes prior to emergence of the dilatation and enlargement that can be identified with US [20,21]. Fulminant PID on CT demonstrates fluid in the endometrial canal, distended and thickened fallopian tubes with wall enhancement, and ovarian enlargement [12,20,22]. CT findings late in the course of PID with formation of a tubo-ovarian abscess includes a complex cystic mass with thick enhancing walls [14,22] and anterior displacement of the mesosalpinx, which helps to distinguish tubo-ovarian abscess from other sources of abscess formation in the pelvis [12,22,23]. MRI Pelvis MRI is most often utilized as a problem-solving examination if US or CT do not reveal an etiology of pain. Potential benefits of MRI in the acute pelvic pain setting are high spatial resolution and excellent soft-tissue contrast. This allows for more precise localization and origin of pathology identified on US and CT [12,24].