Purpose or Case Report: Acute onset pelvic pain in a pubertal girl has many possible etiologies. Reproductive, urinary and gastrointestinal pathology all can underlie acute onset pelvic pain in this age group and may have similar presentations. We present a series of six cases in which MRI was utilized for further evaluation of US findings and either confirmed the need for surgical intervention, or established the cause of pain and eliminated the need for surgery.
Methods & Materials: Both focused MRI for evaluation of appendicitis and dedicated, brief pelvic MRI protocols are utilized in our institution for further investigation of pelvic/right lower quadrant pain and abnormal pelvic ultrasound findings. Six cases are presented culled from our teaching file that demonstrate the utility of MRI in clarifying pelvic pathology in the emergent setting.
Results: MRI evaluation of the appendix can confirm or eliminate a diagnosis of appendicitis. In addition, the high soft tissue contrast inherent in MRI can detect intra-ovarian pathology such as hemorrhagic or corpus luteum cysts. Diffusion weighted imaging and contrast are helpful in identifying ovarian torsion. These studies can be performed in most instances in less than 30 minutes.
Conclusions: The most worrisome potential etiologies of acute pelvic pain are those requiring emergent surgery: acute appendicitis, ovarian torsion, and ectopic pregnancy. Since pregnancy can be established prior to imaging, and, if present, warrants ultrasound, this entity is not be discussed here. Given the need for timely evaluation, an organized approach to the imaging work up is needed for efficient diagnosis and to avoid unnecessary radiation exposure. Our institution utilizes pelvic and/or appendiceal ultrasound followed by tailored MRI if the ultrasound findings are inconclusive or do not fit the clinical diagnosis. Further imaging evaluation prior to discharge or laparoscopy can direct appropriate management eliminating unnecessary radiation and surgery.