Ultrasound Evaluation of Gynecologic Causes of Pelvic Pain

Acute pelvic pain, defined as noncyclic pain lasting for less than 3 months, is a common presenting symptom of premenopausal women in an emergency department or physician's office. Acute pelvic pain is a nonspecific symptom and there is a broad range of gynecologic and nongynecologic causes, including gastrointestinal, urologic, and musculoskeletal etiologies. Acute pelvic pain is often associated with other nonspecific signs and symptoms, including nausea, vomiting, and leukocytosis. Hence, imaging is frequently required to narrow the differential diagnosis, and endovaginal ultrasound (EVUS) is the most widely accepted initial imaging modality of choice if there is high clinical suspicion for obstetric or gynecologic etiologies.(1) Chronic pelvic pain is defined as noncyclic pain lasting longer than 6 months. Approximately 14% of women in the United States report symptoms of chronic pelvic pain, but the cause is often undiagnosed.(2,3) The most common gynecologic causes of chronic pelvic pain include adenomyosis, endometriosis, leiomyomas, adhesions, and pelvic congestion syndrome.(4) Ultrasound (US) is most helpful in the diagnosis of leiomyomas, adenomyosis, and endometriosis. This article reviews the role of US in the evaluation of gynecologic causes of acute and chronic pelvic pain.