Female patients with acute lower abdominal or pelvic pain often represent a diagnostic challenge. The differential diagnosis is broad (Table 18-1), and the workup often requires multiple diagnostic tests. Ultrasound is the initial diagnostic imaging modality of choice in the majority of cases. Point-of-care ultrasound (POCUS), performed and interpreted by the clinician and completed at the time of the initial physical examination, helps narrow the differential diagnosis and may eliminate the need for further diagnostic testing.
TABLE 18-1.DIFFERENTIAL DIAGNOSIS OF LOWER ABDOMINAL PAIN IN FEMALE PATIENTS |Favorite Table|Download (.pdf) TABLE 18-1. DIFFERENTIAL DIAGNOSIS OF LOWER ABDOMINAL PAIN IN FEMALE PATIENTS
Inflammatory bowel disease
Irritable bowel syndrome
Small bowel obstruction
Pelvic inflammatory disease
Hemorrhagic functional cysts
Ovarian hyperstimulation syndrome
Imaging the pelvis is a crucial step in the evaluation of women with lower abdominal pain or pelvic pain. Accurate management is predicated on choosing the most effective diagnostic tool. Four diagnostic modalities are available for evaluating the pelvis: ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and laparoscopy.
Ultrasound has proven to be a rapid, noninvasive, portable, repeatable, inexpensive, and accurate method for visualizing and diagnosing pathology within the pelvis. Several advantages over CT, MRI, and even the bimanual pelvic examination have made ultrasound the first-line diagnostic imaging modality in patients with acute pelvic pain or masses.1−3 Both transabdominal and transvaginal ultrasound can be used by the clinician at the point of care during the initial physical examination. The use of POCUS has far-reaching benefits to patient care. It may identify specific diseases in the differential diagnosis and often eliminates the need for expensive and time-consuming diagnostic tests (Figure 18-1). In addition, ultrasound does not expose patients to ionizing radiation. As the clinician performs the POCUS examination, patients may be more satisfied with their visit.4 This serves to provide patients with more time to ask questions, comprehension of the diagnosis, and confidence in their treating clinician.
The top image demonstrates transverse placement of a large footprint curved array transducer. The bottom image depicts a complex ovarian mass, one of the many entities that lies within the differential diagnosis for women presenting with acute pelvic pain.
The main disadvantage of ultrasound with respect to the other imaging modalities is its limited scope. CT and MRI may yield valuable information about other organ system pathology and the extent to which a disease process may have progressed. In addition, sonographic images may be technically inadequate due to interference from bowel gas.
While CT is used routinely ...