Discussion of Procedures by Variant Variant 1: Postmenopausal acute pelvic pain. Initial imaging. CT Abdomen and Pelvis CT abdomen and pelvis may be useful in the setting of poorly localized pain, masses, or organomegaly involving both the abdomen and pelvis as well as in assessment of abdominal vasculature and ascites. CT is useful in the evaluation of patients with a nonspecific clinical presentation or broad differential diagnosis, including gynecologic and nongynecologic etiologies, and may be a first-line imaging modality in this setting. CT with intravenous (IV) contrast had higher sensitivity than ultrasound (US) (89% versus 70%) for urgent diagnoses in a mixed-gender group of adults with abdominopelvic pain [5], and approximately 88% overall accuracy compared with surgical diagnosis in a similar cohort [6]. Although specific data are lacking for the postmenopausal population, CT is also widely used as a second-line imaging modality in patients with an equivocal or nondiagnostic US evaluation, particularly when there is concern for appendicitis [7,8]. The bulk of evidence to support the use of a CT abdomen and pelvis in acute postmenopausal pelvic pain refers to contrast-enhanced imaging. For gynecologic diagnoses, contrast-enhanced CT may identify ovarian cysts and masses, including solid components, as well as ascites, or lymphadenopathy that may raise suspicion for a malignant diagnosis [9-11]. However, the accuracy of CT for adnexal mass characterization remains limited. CT is distinctly helpful when macroscopic fat or calcifications of teeth or bone fragments are present, to confirm the diagnosis of ovarian teratoma. Regarding ovarian torsion, CT findings have been described but specific diagnostic accuracy has not been reported to our knowledge.
Postmenopausal Acute Pelvic Pain. Discussion of Procedures by Variant Variant 1: Postmenopausal acute pelvic pain. Initial imaging. CT Abdomen and Pelvis CT abdomen and pelvis may be useful in the setting of poorly localized pain, masses, or organomegaly involving both the abdomen and pelvis as well as in assessment of abdominal vasculature and ascites. CT is useful in the evaluation of patients with a nonspecific clinical presentation or broad differential diagnosis, including gynecologic and nongynecologic etiologies, and may be a first-line imaging modality in this setting. CT with intravenous (IV) contrast had higher sensitivity than ultrasound (US) (89% versus 70%) for urgent diagnoses in a mixed-gender group of adults with abdominopelvic pain [5], and approximately 88% overall accuracy compared with surgical diagnosis in a similar cohort [6]. Although specific data are lacking for the postmenopausal population, CT is also widely used as a second-line imaging modality in patients with an equivocal or nondiagnostic US evaluation, particularly when there is concern for appendicitis [7,8]. The bulk of evidence to support the use of a CT abdomen and pelvis in acute postmenopausal pelvic pain refers to contrast-enhanced imaging. For gynecologic diagnoses, contrast-enhanced CT may identify ovarian cysts and masses, including solid components, as well as ascites, or lymphadenopathy that may raise suspicion for a malignant diagnosis [9-11]. However, the accuracy of CT for adnexal mass characterization remains limited. CT is distinctly helpful when macroscopic fat or calcifications of teeth or bone fragments are present, to confirm the diagnosis of ovarian teratoma. Regarding ovarian torsion, CT findings have been described but specific diagnostic accuracy has not been reported to our knowledge.