[Computerized tomography in the differential diagnosis of non-gynecologic abdomino-pelvic masses]

The female pelvis is an anatomical region where masses can be found originating from pelvic organs, mostly from the genital system or else from abdominal organs and systems, by continuity, by contact or by metastatic spread. The clinician needs to define and characterize a pelvic mass since treatment options can vary greatly. If a malignant pelvic lesion is clinically suspected, ultrasonography is the investigation technique of choice, whose differential diagnosis accuracy is good especially in gynecologic conditions. However, in nongynecologic masses, US diagnostic yield is poorer, which led us to retrospectively review 31 such cases. CT was used to assess the mass origin and tissue characterization to define the clinical role of this method. On the whole, CT yielded good results (80.6% overall diagnostic accuracy, 25/31 cases) which however differed according to the different pathologic conditions. Gastrointestinal system conditions, tumors and inflammations were easy to diagnose with CT (11/15 cases, 73.3%), except for the patients with intestinal cancer spreading to the ovaries, that is, a Krukenberg's lesion, or the cases with an abscess hiding the annexa and thus preventing CT from detecting the mass origin, be it intestinal or annexial. CT diagnostic accuracy was high in extraperitoneal (retro- and properitoneal) masses (8/8 cases, 100%), but much lower (75%, 6/8 cases) in the diagnosis of primary intraperitoneal organs conditions. To conclude, CT is confirmed as an accurate imaging technique in the differential diagnosis of nongynecologic abdominopelvic masses. The mass origin is usually correctly detected and tissue characterization is accurate, which provides the clinician with enough pieces of information for best treatment planning.