Pelvic pain, adnexal masses, and ultrasound

Pelvic pain, acute or chronic, accounts for more than 10% of referrals to gynecologists. Pain accounts for more than 40% of gynecologic diagnostic laparoscopies. Predicting operative findings is critical in planning surgical interventions, as well as preoperative and postoperative medical therapy. Ultrasound is useful in preoperative evaluation and in predicting surgical findings. This section reviews the use of various ultrasound modalities in evaluating adnexal masses and associated pelvic pain. Morphologic assessment with two-dimensional (2-D) ultrasound is the foundation for adnexal evaluation. The ultrasound morphology of common ovarian and adnexal masses is reviewed. The application and reliability of Doppler assessment is also reviewed. New advances, such as three-dimensional (3-D) sonography, 3-D vascular assessment, and contrast imaging, augment diagnostic accuracy. These advances may find future application in the clinical evaluation of patients. This section reviews the application of 2-D morphology, Doppler analysis, 3-D morphology, rendering and vascular assessment, and the use of contrast agents in the ultrasound evaluation of patients with adnexal masses and pelvic pain.