No abstract

Objective: Gynecological emergencies continue to be a diagnostic challenge. Although ultrasound is an excellent first line imaging modality, there are many instances where sonographic findings are indeterminate. The purpose of this study was to assess the emerging role of MRI in gynecological emergencies. Methods: 88 patients with acute pelvic pain or bleeding per vagina who underwent MRI at our imaging department between October 2012 and September 2014 were reviewed. The final diagnosis was established by surgical findings in 69 cases, endovascular intervention & biopsy in 1 respectively. The remaining 17 cases underwent follow-up MRI. Results: MRI was diagnostic in 84 (95.5%) out of 88 patients and non-diagnostic in 4 cases. The commonest gynecological emergency was pelvic inflammatory disease. Imaging findings in 71 (80.7%) patients were correlated with surgery or biopsy. The overall sensitivity and PPV of MRI in acute gynecological pathologies was 96.6% and 98.8%. Conclusion: Women presenting to the emergency room with acute pelvic pathology require prompt diagnosis to ensure timely management. MRI is superior to ultrasound in pelvic lesion characterization and is the problem solving modality when initial ultrasound is inconclusive. Our study demonstrated that MRI can play a significant role in providing accurate diagnosis in gynecological emergencies.

Ectopic parathyroid glands tend to be located in positions defined by their embryologic path during fetal development. We describe such a case of primary hyperparathyroidism due to ectopic retropharyngeal parathyroid adenoma (PTA) in a teenage girl with mild symptomatology. The initial workup with scintigraphy showed suspicious uptake above the level of thyroid gland, ultrasound, and computed tomography failed to localize an adenoma. Magnetic resonance imaging precisely localized an ectopic retropharyngeal PTA, which led to successful surgical removal.