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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The advent of MRI has improved the ability of the diagnostic radiologist to provide useful clinical information to the practicing gynecologist. Although US remains the screening procedure of choice for evaluation of the uterus and adnexa because of its relative safety and low cost, MRI is now considered the next imaging step. In a woman with pelvic pain, MRI can accurately identify adenomyosis, enumerate and localize uterine fibroids, and provide more accurate identification of endometriosis and cystic teratomas of the ovary than US. Although MRI should not be used as a screening procedure for diagnosing endometrial or cervical carcinoma, it can aid in patient management by determining the extent of myometrial or cervical invasion by endometrial carcinoma and can be used to calculate tumor volume in patients with cervical carcinoma. Early studies suggest that MRI may be helpful in distinguishing between long-term radiation fibrosis and tumor recurrence in such patients. MRI findings may be highly indicative of the presence of ovarian malignancy, but the procedure adds little to CT or US findings. Nevertheless, MRI is superior in the localization of pelvic masses and is often indicated in clarifying the origin of a mass as uterine or ovarian.
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PMID:Applications of magnetic resonance imaging to gynecology. 218 59

A practical MRI strategy for the investigation of pelvic pain in patients with suspected recurrent lymphoma is described and illustrated in five patients. A T1-weighted sagittal examination of the lumbo-sacral spine is used to examine the vertebral bone marrow, spinal canal, exit foraminae and para-aortic lymph nodes. T2-weighted and balanced images are obtained in the axial plane through the pelvis. The balanced images give an excellent demonstration of pelvic lymph nodes and the T2-weighted images are sensitive to the presence of abnormal soft tissue masses and marrow disease.
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PMID:Magnetic resonance imaging in extranodal pelvic lymphoma. 222 32

Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly with the extent of disease. Symptoms of genital endometriosis may be categorized as menstrual dysfunction, ovulatory dysfunction, and reproductive dysfunction. With menstrual dysfunction, the frequent clinical symptoms are cyclic pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is commonly found to be the cause in younger patients with pain and dysmenorrhea, particularly when the clinician is aware of the appearance of atypical lesions. Types of ovulatory dysfunction reported to be associated with endometriosis include anovulation, premenstrual spotting, luteal phase defects, and LUF syndrome. The data are not sufficient to determine the prevalence of endometriosis, luteal phase defects, and hyperprolactinemia. With LUF syndrome, there are data to support an association, but more data on the frequency of LUF in consecutive normal cycles compared to consecutive cycles in women with endometriosis would be beneficial. A higher rate of infertility is reported in couples with endometriosis. Two approaches are used to evaluate spontaneous abortions and endometriosis. In retrospective studies, the abortion rates are higher in couples with endometriosis; however, when the pregnancy outcomes in untreated couples are studied, there is less evidence to support the association of a higher spontaneous abortion rate. Formerly, the diagnosis of endometriosis depended on the appearance of typical lesions. With the recognition of early or atypical lesions the histologic confirmation of glands and stroma is assuming a more prominent role. Noninvasive techniques such as assays of endometrial antibodies or CA-125 have certain limitations in terms of producing false-positive results and lacking predictability in early stages of disease. Ultrasonography and MRI give additional and confirmatory information. Most noninvasive techniques are ancillary in diagnosis and management. It still needs to be determined whether their routine use will give enough added information to justify their cost. Currently, the diagnosis of endometriosis is best made by histologic evidence of glands and stroma.
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PMID:Clinical presentation and diagnosis of endometriosis. 266 21

The authors present a case of sacral meningeal cyst (s.m.c.) being the cause of chronic pain related to perineal, sacral and pelvic regions. The aim of the report is to emphasize the role played by s.m.c. in the aetiology of pain arising in these regions. As it can result from a wide variety of pathologies, like gynaecological, urological and anorectal the differential diagnosis is very difficult. Until recent years s.m.c. was rarely encountered in clinical practice and identified as a cause of chronic pain in perineal, sacral or pelvic areas. Now in the era of MRI and with increasing access to sophisticated imaging diagnostic methods s.m.c. will probably be recognized in more cases of perineal, sacral or pelvic pain.
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PMID:[Sacral meningeal cyst as a cause of chronic pain related to perineal, sacral and pelvic regions]. 823 44

Endometriosis is relatively frequent in females of menstrual age and consists in the appearance of active endometrial tissue at site other than uterine cavity. Endometrial tissue has been described to colonise the urinary system, particularly the urinary bladder. The most common clinical features of vesical endometriosis are urgency and frequency, hypogastric pain and hematuria. We report on a case of vesical endometriosis whose presenting features were dysmenorrhea, stranguria and pelvic pain. MRI and CT did not provide different or more precise information than ultrasound scan: these findings were indistinguishable from an intrauterine lesion. On the contrary endovaginal sonography was more sensitivity than MRI and CT. Cystoscopy was negative. Nondiagnostic laparoscopy was performed. Patient underwent laparotomy and partial cystectomy. Histopatological findings demonstrated an endometriosis of the muscle layer of the bladder. The rarity of this condition prompted us to report on the problems encountered in making the differential diagnosis.
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PMID:[Echographic, MRI and CT features in a case of bladder endometriosis]. 916 60

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal-neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders.
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PMID:Surgical treatment for chronic pelvic pain. 987 26

Pelvic varices in women consist of tortuous and dilated parauterine and ovarian veins and have a characteristic appearance at CT and MRI. Imaging is critical in the evaluation of pelvic varices, both to prevent confusion with other conditions and because pelvic varices may be secondary to serious underlying pathology. Additionally, primary pelvic varices are associated with the pelvic pain syndrome, and patients with the pelvic pain syndrome may benefit from therapeutic venous embolization. Secondary pelvic varices are rarely associated with pelvic pain.
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PMID:CT and MRI of pelvic varices in women. 1034 50

Background: Adnexal torsion is a well-recognized cause of acute pelvic pain. Isolated tubal torsion with ovarian sparing has certainly been documented, but is uncommon. Although risk factors for the latter include a menstrual period, menarche in particular is not known to predispose a patient to this event. Severe unilateral pelvic pain with first menses is more likely to herald a congenital mullerian anomaly and cryptomenorrhea, particularly when accompanied by a pelvic mass. We present a case of tubal torsion where a coincidental, yet misleading temporal relation to menarche led to a delay in laparoscopy and ultimate diagnosis.Case: KG, an eleven-year-old female, experienced severe right-sided dysmenorrhea with her first and second menses in August and September 1999 respectively. Between episodes, pain, although still present, was more tolerable and the patient never required hospitalization. Ultrasound revealed a lobulated inhomogeneous mass posterior to the uterus and extending from one normal ovary to the other (Figures). MRI further described the mass as pseudoencapsulated with inhomogeneous areas of high attenuation on T1 and T2 images (Figures). Findings were consistent with an endometrioma, but admittedly could have represented a hemorrhagic cystic mass. No definite mullerian anomaly was seen to explain advanced endometriosis, but two focal areas within the endometrial canal raised the possibility of a uterine septum. Examination of the patient (one week after presentation) was not very helpful although she was pubertal, did have a hymenal septum and was mildly tender on bimanual examination in the Pouch of Douglas. The patient had been started on continuous oral contraceptives while undergoing investigations. Pain only recurred during an episode of break-through bleeding. Ultimately she came to laparoscopy and hysteroscopy where chronic right tubal torsion and necrosis was identified with an inflammatory/hemorrhagic reaction in the pelvis (Photos). There were no identifiable fimbria of the right tube which was densely adherent distally to perirectal fat (Photo). No obvious precipitant was found. Laparoscopic lysis of adhesions and right distal salpingectomy was performed (Photo). Her uterine cavity was in fact normal (Photo)Conclusion: Whether or not this patient's right tube was originally normal will never be known. Congenital abnormalities of fallopian tubes do occur and can predispose to torsion. Nonetheless, adnexal torsion must always be kept in mind whenever a woman presents with unilateral pelvic pain. Early diagnosis is paramount in children and women of reproductive age in order to improve the likelihood of adnexal salvage and future fertility. A "gold-standard" radiological investigative tool continues to elude us. Laparoscopy, albeit more invasive, remains an invaluable procedure in this context with relatively low morbidity as compared to the consequences of delayed diagnosis.
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PMID:Isolated tubal torsion at menarche- a case report 1086 84

Female genital tract anomalies are common (1 to 2% of the female population), and may lead to multiple clinical manifestations: amenorrhea, infertility, spontaneous repeated miscarriage, pelvic pain, endometriosis. They are caused by intra-uterine insults between weeks 6 and 18 of gestation. They are classified according to their embryologic origin. Imaging relies essentially on ultrasound and MRI, and indications for hysterosalpingography are less common. Imaging must classify the malformation and detect complications in order to assess the fertility prognosis and treat complications.
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PMID:[Imaging of gynecologic malformations]. 1191 48

The purpose of this study was to determine the prevalence and the distribution as well as male/female differences in patients with hip or pelvic pain based on MRI results. Three hundred forty consecutive conscripts (45 women, 295 men; age range 18-29 years; mean age 20.7 years) suffering from stress-related hip, buttock or groin pain took part in the study. All 340 patients underwent MR imaging. Radiographic data were available for 215 patients. Two radiologists interpreted the images by consensus. In MRI 174 stress injuries were diagnosed in 137 patients (32 women, 105 men). The incidence of bone stress injuries in women was significantly higher than that in men ( p<0.0001). One hundred five of the injuries (60%) were related to the proximal femur, 70 (67%) to the neck, 34 (32%) to the proximal shaft, and one (1%) to the head. Sixty-nine of the 174 stress injuries (40%) concerned the pelvic bones: sacrum 28 (41%); inferior pubic ramus 34 (49%); superior pubic ramus 3 (4%); iliac bone 3 (4%); and acetabulum 1 (1%). In 31 of the 174 cases (18%) symptoms were contralateral to MR findings. Thirty-three of the 137 patients (24%) had multiple bone stress injuries, 29 had two bone stress injuries and 4 patients had three. The sensitivity of radiography was 37%, specificity 79%, accuracy 60%, positive predictive value 59% and negative predictive value 61%. The kappa value for agreement between radiography and MRI was poor (0.17, p=0.0008). Patients suffering from stress-related hip pain MRI revealed bone stress injuries in 40%; of these, 60% were located in the proximal femur and 40% in the pelvic bones. For accurate diagnosis of bone stress injuries, and to ensure appropriate treatment, the entire pelvis and both proximal femurs should be studied simultaneously by means of MRI.
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PMID:Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. 1259 65


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