Female ; Humans ; Pelvic Inflammatory Disease/diagnosis* ; Intrauterine Devices

Acute pelvic pain is one of the most common complaints of woman presenting in the emergency department. When gynecologic disorders are suspected, ultrasonography (US) is the modality of choice, enabling rapid diagnosis and decision making with regard to appropriate management. Frequent gynecologic etiologies include a large or enlarging simple ovarian cyst, hemorrhagic ovarian cyst or rupture of an ovarian cyst, acute pelvic inflammatory disease, and ovarian torsion. Endometriosis, uterine leiomyoma, and peritoneal inclusion cyst can also present as acute pelvic pain. Gynecologic disorders that cause acute pelvic pain frequently show characteristic ultrasonographic findings that enable specific diagnosis. In this review, the authors review ultrasonographic findings of gynecologic causes of acute pelvic pain.
Decision Making ; Diagnosis ; Emergency Service, Hospital ; Endometriosis ; Female ; Gynecology ; Humans ; Leiomyoma ; Ovarian Cysts ; Pelvic Inflammatory Disease ; Pelvic Pain* ; Rupture ; Ultrasonography*

PURPOSE: The aim of this study was to determine whether hyperechoic fatty tissue (HFT) at transabdominal and transvaginal ultrasonography in women with acute pelvic pain has a diagnostic role. MATERIALS AND METHODS: We studied 201 women (mean age, 32 years) with acute pelvic and lower abdominal pain; we performed ultrasonography (US) in all them. Of the 201, 94 with gynecological problems were included., They were divided into two groups: with pelvic inflammatory disease (PID; n = 45) and without PID (n = 49). We evaluated the presence and distribution of HFT and its role in differential diagnosis between PID and non-PID groups. RESULTS: We found, using US, HFT in 36/45 (80%) patients with PID by US. Of the 36, single-center HFT was observed in 12/36 (33.3%) patients and multicentric HFT was detected in 24/36 (66.7%). HFT was present adjacent to inflammatory foci, tuboovarian abscesses or inflamed salpinx in 30 women; HFT was present outside the pelvic cavity in 24. Among the latter 24, HFT was present only in the lower abdomen, and not in the pelvic cavity in 6. In the non-PID group, HFT was found in the lower abdomen and pelvic cavity in 7 women. Four of the seven were misdiagnosed with PID. One of seven women with a hemorrhagic corpus luteal cyst rupture with underlying PID and two with ectopic pregnancy with HFT were correctly diagnosed. CONCLUSION: The presence of HFT may be a reliable US finding for the diagnosis of PID. HFT distinguishes PID from other acute gynecological problems.
Abdomen ; Abscess ; Adipose Tissue ; Diagnosis, Differential ; Fallopian Tubes ; Female ; Humans ; Pelvic Inflammatory Disease ; Pelvic Pain ; Pelvis ; Pregnancy ; Pregnancy, Ectopic ; Rupture

Abdominal pregnancy is very rare and potentially life-threatening variation of ectopic pregnancy. Early diagnosis is very difficult. In the last several decades prenatal care has improved and noninvasive procedures such as ultrasound scanning and fetal cardiotocography have led to us a better assessment of fetal and maternal disorders. In the last 30 years an increase of diagnosed ectopic pregnancies has been noted and attributed to the greater frequency of pelvic inflammatory disease. Although the incidence of ectopic pregnancy is rising, the incidence of abdominal pregnancy, which is primarily a sequel of a missed ruptured ectopic pregnancy, remains low. We presented a case of secondary abdominal pregnancy in 14 wks with its review of literature.
Cardiotocography ; Early Diagnosis ; Female ; Incidence ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic ; Prenatal Care ; Ultrasonography

Pelvic actinomycosis is an uncommon infectious disease. It induces a chronic, suppurative illness characterized by an infiltrative and granulomatous response and, thus, the clinical and radiologic findings may mimic other inflammatory and neoplastic conditions. A 56-year-old female with a long-standing intrauterine device was diagnosed with pelvic actinomycosis manifesting as a large uterine mass with locally infiltrative spread into surrounding tissue that mimicked uterine malignancy. Actinomyces israelii infection was confirmed with a surgical specimen, and the patient was treated with antibiotic medication. Pelvic actinomycosis must be included in the differential diagnoses of patients with an infiltrative pelvic mass extending across tissue planes or in patients with findings of multiple microabscesses, particularly in a patient with an intrauterine device, even the lesion primarily involves the uterus.
Actinomyces ; Actinomycosis ; Communicable Diseases ; Diagnosis, Differential ; Female ; Humans ; Intrauterine Devices ; Middle Aged ; Pelvic Inflammatory Disease ; Uterus

Fitz-Hugh-Curtis syndrome has been defined as perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhoeae and Chlamydia trachomatis. In the acute phase, patients usually complain of severe right upper quadrant pain of sudden onset. The pain is sharp, pleuritic and most intense at the level of the right lower rib margin and thus it is frequently confused with acute cholecystitis or pleurisy. Definitive diagnosis of Fitz-Hugh-Curtis syndrome needs invasive procedures such as laparoscopy or laparotomy, but considering that Fitz-Hugh-Curtis syndrome is a benign condition that can be cured by oral administration of appropriate antibiotics, noninvasive diagnosis is desirable. Recently, we have experienced two cases of Fitz-Hugh-Curtis syndrome in acute phase accompanied with sharp and pleuritic right upper quadrant pain. In one case, pelvic inflammatory disease was not definite, so at first we mistook it for acute cholecystitis and reactivation of chronic hepatitis B. In the other case, Fitz-Hugh-Curtis syndrome followed the preceding, typical pelvic inflammatory disease. Both cases were diagnosed noninvasively and treated successfully by oral administration of antibiotics.
Adult ; Chlamydia Infections/*diagnosis ; *Chlamydia trachomatis ; Diagnosis, Differential ; Female ; Gonorrhea/*diagnosis ; Hepatitis/*diagnosis ; Humans ; Pelvic Inflammatory Disease/*diagnosis ; Syndrome

Retroperitoneal fibrosis was first described in 1905 by Albarran, a French urologist, who performed ureterolysis for ureteral compression produced by the disease. However, this disease became an established clinical entity by Ormond's account in the English literature in 1948. Pericystitis plastica has been used the define an extremely rare type of Idiopathic retroperitoneal fibrosis (IRF) constricting the bladder. In this study, we discussed the recovery of 29-year-old woman with pericystitis plastica who was misdiagnosed as pelvic malignancy or a chronic/subacut pelvic inflammation at the first evaluation.
Adult ; Cystitis/*radiography ; Diagnosis, Differential ; Female ; Human ; Pelvic Inflammatory Disease/*radiography ; Pelvic Neoplasms/*radiography ; Retroperitoneal Fibrosis/*radiography ; *Tomography, X-Ray Computed

Two adolescent cases of Fitz-Hugh-Curtis syndrome, which has not been previously reported in Korean girls, presenting with right upper-quadrant abdominal pain, nausea, vomiting, and fever are reported here. A careful and thorough inquiry into the sexual history of the first patient, which was not done upon admission, led to a careful reassessment of the dynamic abdominal computed tomography scan revealing hepatic capsular enhancement without evidence of gallbladder or liver disease. Both cases were diagnosed noninvasively and were treated successfully by medical intervention. A high index of suspicion of Fitz-Hugh-Curtis syndrome should be implemented in the differential diagnosis of right upper quadrant pain, particularly in sexually active girls, for a prompt diagnosis and rapid cure.
Abdominal Pain ; Adolescent ; Chlamydia Infections ; Diagnosis, Differential ; Female ; Fever ; Gallbladder ; Hepatitis ; Humans ; Liver Diseases ; Nausea ; Pelvic Inflammatory Disease ; Peritonitis ; Vomiting

Two adolescent cases of Fitz-Hugh-Curtis syndrome, which has not been previously reported in Korean girls, presenting with right upper-quadrant abdominal pain, nausea, vomiting, and fever are reported here. A careful and thorough inquiry into the sexual history of the first patient, which was not done upon admission, led to a careful reassessment of the dynamic abdominal computed tomography scan revealing hepatic capsular enhancement without evidence of gallbladder or liver disease. Both cases were diagnosed noninvasively and were treated successfully by medical intervention. A high index of suspicion of Fitz-Hugh-Curtis syndrome should be implemented in the differential diagnosis of right upper quadrant pain, particularly in sexually active girls, for a prompt diagnosis and rapid cure.
Abdominal Pain ; Adolescent ; Chlamydia Infections ; Diagnosis, Differential ; Female ; Fever ; Gallbladder ; Hepatitis ; Humans ; Liver Diseases ; Nausea ; Pelvic Inflammatory Disease ; Peritonitis ; Vomiting

PURPOSE: We wanted to determine the usefulness of the computed tomography (CT) findings for making the diagnosis between periappendiceal inflammation (PAI) with appendicitis and pelvic inflammatory disease (PID) for the women presenting with right lower quadrant pain. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of 83 women with right lower quadrant pain: PAI in 36 and PID in 47 patients. We reviewed the CT images, including the appendiceal diameter and the enhancing wall thickening, the cecal thickening, the location of the appendix, thickening of the right anterior renal fascia, abscess, mesenteric fatty infiltration, ascites, heterogeneous uterine enhancement and paralytic ileus. Statistical analysis was performed by using the t-test for the diameter of appendix, and the x2 test or Fisher's exact test for the CT findings. RESULTS: The mean diameter of the appendix was 11.0+/-3.4 mm for the PAI subjects and it was 6.7+/-2.0 mm for the PID subjects (p<0.0001). Wall thickening of the appendix was more commonly detected in PAI (25 subjects, 69%) than in PID (15 subjects, 32%) (p=0.0007). Thickening of the right anterior renal fascia was more commonly detected in PAI (18 subjects, 50%) than in PID (7 subjects, 15%). Cecal thickening, ascitis, heterogeneous uterine enhancement and paralytic ileus were not significantly different between PAI and PID. Abscess and mesenteric fatty infiltration were more frequently detected in the RLQ, and in the abdomen or pelvic cavity in PAI and PID, respectively (p<0.05). There was no significant difference in the distribution of ascites between the diseases. CONCLUSION: The CT findings of the appendiceal diameter, enhancing wall thickening and thickening of the right anterior renal fascia are useful for making the diagnosis of PAI. The abdominal and pelvic distributions of abscess and mesenteric fatty infiltration are highly suggestive findings of PID.
Abdomen ; Abscess ; Appendicitis* ; Appendix ; Ascites ; Diagnosis ; Fascia ; Female ; Humans ; Inflammation* ; Intestinal Pseudo-Obstruction ; Pelvic Inflammatory Disease* ; Retrospective Studies