HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eyvazzadeh, A. D. Articles by Levine, D. Search for Related Content PubMed PubMed Citation Articles by Eyvazzadeh, A. D. Articles by Levine, D. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

MRI of Right-Sided Abdominal Pain in Pregnancy

¹ Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
² Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215.

View larger version (132K): [in a new window]   Fig. 1A. —Normal appendix in 32-year-old woman at 28 weeks' gestation. Coronal half-Fourier single-shot fast spin-echo images (TR/TE, single shot/65; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show normal appendix localized in right upper quadrant (arrowheads, A) secondary to superior displacement of cecum (C) by enlarged gravid uterus. Arrow (B) points to tip of appendix.

View larger version (154K): [in a new window]   Fig. 1B. —Normal appendix in 32-year-old woman at 28 weeks' gestation. Coronal half-Fourier single-shot fast spin-echo images (TR/TE, single shot/65; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show normal appendix localized in right upper quadrant (arrowheads, A) secondary to superior displacement of cecum (C) by enlarged gravid uterus. Arrow (B) points to tip of appendix.

View larger version (131K): [in a new window]   Fig. 2A. —Mild acute appendicitis in 27-year-old woman at 13 weeks' gestation. Coronal (A) and axial (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show enlarged fluid-filled appendix (arrow) measuring 9 mm in diameter. Note increased signal intensity (arrowheads, A) in mesoappendix consistent with inflammatory changes. Mild acute appendicitis was confirmed both at surgery and pathology examination. In B, U = gravid uterus.

View larger version (99K): [in a new window]   Fig. 2B. —Mild acute appendicitis in 27-year-old woman at 13 weeks' gestation. Coronal (A) and axial (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show enlarged fluid-filled appendix (arrow) measuring 9 mm in diameter. Note increased signal intensity (arrowheads, A) in mesoappendix consistent with inflammatory changes. Mild acute appendicitis was confirmed both at surgery and pathology examination. In B, U = gravid uterus.

View larger version (147K): [in a new window]   Fig. 3A. —Appendiceal phlegmon in 29-year-old woman at 27 weeks' gestation. MRI was performed to document size of phlegmon because surgeons preferred to treat patient with antibiotics if phlegmon was sizeable. Sonogram reveals heterogeneous mass (arrows) in right lower quadrant in region of patient's pain, which can be indicative of appendicitis with phlegmon.

View larger version (127K): [in a new window]   Fig. 3B. —Appendiceal phlegmon in 29-year-old woman at 27 weeks' gestation. MRI was performed to document size of phlegmon because surgeons preferred to treat patient with antibiotics if phlegmon was sizeable. Coronal half-Fourier single-shot fast spin-echo image (TR/TE, single shot /62; flip angle, 130°; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) shows heterogeneous, moderately hyperintense mass (arrowheads) in right lower quadrant, consistent with inflammatory phlegmon.

View larger version (119K): [in a new window]   Fig. 3C. —Appendiceal phlegmon in 29-year-old woman at 27 weeks' gestation. MRI was performed to document size of phlegmon because surgeons preferred to treat patient with antibiotics if phlegmon was sizeable. Axial fat-saturated half-Fourier single-shot fast spin-echo image (single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 30 cm; and slice thickness, 6 mm) shows markedly enlarged appendix 2 cm in diameter (arrowheads) surrounded by inflammatory phlegmon. Patient was treated with IV antibiotics. Follow-up MR image (not shown) obtained 5 weeks later showed no change. Cesarean delivery was performed at 33 weeks' gestation, and appendectomy performed at delivery confirmed appendicitis.

View larger version (129K): [in a new window]   Fig. 4A. —Appendiceal stump in 20-year-old woman with right-sided abdominal pain and leukocytosis at 21 weeks' gestation. Patient had undergone appendectomy 13 days before examination. Axial (A) and sagittal (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) obtained at level of cecum (C, B) shows heterogeneously hyperintense masslike appendiceal stump (arrow) with central high signal intensity due to fluid. Right ovary (arrowhead) is seen in B.

View larger version (111K): [in a new window]   Fig. 4B. —Appendiceal stump in 20-year-old woman with right-sided abdominal pain and leukocytosis at 21 weeks' gestation. Patient had undergone appendectomy 13 days before examination. Axial (A) and sagittal (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) obtained at level of cecum (C, B) shows heterogeneously hyperintense masslike appendiceal stump (arrow) with central high signal intensity due to fluid. Right ovary (arrowhead) is seen in B.

View larger version (122K): [in a new window]   Fig. 5A. —36-year-old woman at 35 weeks' gestation with severe right upper quadrant pain. Lipase level was elevated at 5,342 IU/L. MRI was performed to assess for obstructing stones and complications of pancreatitis. Axial half-Fourier single-shot fast spin-echo image (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) shows diffuse edema in gallbladder wall (arrowheads) and gallstones (arrow).

View larger version (157K): [in a new window]   Fig. 5B. —36-year-old woman at 35 weeks' gestation with severe right upper quadrant pain. Lipase level was elevated at 5,342 IU/L. MRI was performed to assess for obstructing stones and complications of pancreatitis. Coronal MR cholangiogram (TR/TE, single shot /1,100; field of view, 35 cm; matrix, 240 x 256; and slice thickness, 20 mm) shows normal intra- and extrahepatic bile ducts (small arrows), cystic duct (large arrow), and pancreatic duct (arrowheads). Patient underwent laparoscopic cholecystectomy after delivery. Intraoperative cholangiogram (not shown) showed no stones in bile ducts.

View larger version (161K): [in a new window]   Fig. 6A. —Physiologic hydronephrosis of pregnancy and enlarged right ovarian vein in 24-year-old woman at 36 weeks' gestation who presented with abdominal pain just superior to and right of her umbilicus. Coronal (A and B) and sagittal (C) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130 °; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show mild right-sided hydronephrosis. Enlarged right ovarian vein (arrows, B) is well visualized as dark tubular structure because of flowing blood. Tapering ureter (arrowhead, C) just posterior to ovarian vein (arrow, C) is well visualized.

View larger version (171K): [in a new window]   Fig. 6B. —Physiologic hydronephrosis of pregnancy and enlarged right ovarian vein in 24-year-old woman at 36 weeks' gestation who presented with abdominal pain just superior to and right of her umbilicus. Coronal (A and B) and sagittal (C) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130 °; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show mild right-sided hydronephrosis. Enlarged right ovarian vein (arrows, B) is well visualized as dark tubular structure because of flowing blood. Tapering ureter (arrowhead, C) just posterior to ovarian vein (arrow, C) is well visualized.

View larger version (127K): [in a new window]   Fig. 6C. —Physiologic hydronephrosis of pregnancy and enlarged right ovarian vein in 24-year-old woman at 36 weeks' gestation who presented with abdominal pain just superior to and right of her umbilicus. Coronal (A and B) and sagittal (C) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/62; flip angle, 130 °; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) show mild right-sided hydronephrosis. Enlarged right ovarian vein (arrows, B) is well visualized as dark tubular structure because of flowing blood. Tapering ureter (arrowhead, C) just posterior to ovarian vein (arrow, C) is well visualized.

View larger version (152K): [in a new window]   Fig. 6D. —Physiologic hydronephrosis of pregnancy and enlarged right ovarian vein in 24-year-old woman at 36 weeks' gestation who presented with abdominal pain just superior to and right of her umbilicus. Axial 2D time-of-flight image (25/9; flip angle, 30°; matrix, 192 x 256; field of view, 37 cm; and slice thickness, 3 mm) shows flow in ovarian vein (arrow).

View larger version (51K): [in a new window]   Fig. 6E. —Physiologic hydronephrosis of pregnancy and enlarged right ovarian vein in 24-year-old woman at 36 weeks' gestation who presented with abdominal pain just superior to and right of her umbilicus. Color Doppler sonogram shows dilated ovarian vein. This structure should be recognized as normal variant during pregnancy and may contribute to renal dilatation in pregnant women. Whether this finding is associated with pelvic pain is unclear.

View larger version (62K): [in a new window]   Fig. 7A. —20-year-old woman at 14 weeks' gestation who presented with right flank pain. Transabdominal sonogram reveals 5-mm obstructing stone (arrow) in distal ureter.

View larger version (133K): [in a new window]   Fig. 7B. —20-year-old woman at 14 weeks' gestation who presented with right flank pain. Axial (B) and sagittal (C) half-Fourier single-shot fast spin-echo images (TR/TE, single shot /62; flip angle, 130°; matrix, 192 x 256; field of view, 31 cm; and slice thickness, 4 mm) obtained 4 days after sonogram show central hypointense filling defect in mid ureter (arrow, B) but no corresponding filling defect within ureter (arrow, C) at same level on sagittal image. Moderate hydronephrosis of right kidney (arrowheads, C) is seen. Multiple similar filling defects noted at different levels on axial images were believed to be flow-related artifacts. Patient's symptoms spontaneously resolved without recurrence. Stone seen on sonogram (A) is not seen on MR images. Either it passed immediately before MRI was performed or failed to visualize because of low sensitivity of MR urography for small stones.

View larger version (106K): [in a new window]   Fig. 7C. —20-year-old woman at 14 weeks' gestation who presented with right flank pain. Axial (B) and sagittal (C) half-Fourier single-shot fast spin-echo images (TR/TE, single shot /62; flip angle, 130°; matrix, 192 x 256; field of view, 31 cm; and slice thickness, 4 mm) obtained 4 days after sonogram show central hypointense filling defect in mid ureter (arrow, B) but no corresponding filling defect within ureter (arrow, C) at same level on sagittal image. Moderate hydronephrosis of right kidney (arrowheads, C) is seen. Multiple similar filling defects noted at different levels on axial images were believed to be flow-related artifacts. Patient's symptoms spontaneously resolved without recurrence. Stone seen on sonogram (A) is not seen on MR images. Either it passed immediately before MRI was performed or failed to visualize because of low sensitivity of MR urography for small stones.

View larger version (134K): [in a new window]   Fig. 8. —31-year-old woman at 24 weeks' gestation who presented with right lower quadrant pain, nausea, vomiting, and elevated WBC of 24,000 µL. Coronal maximum-intensity-projection image reconstruction from a multislice coronal half-Fourier single-shot fast spin-echo acquisition (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 36 cm; and slice thickness, 4 mm) shows moderate hydronephrosis of right kidney. Note perirenal fluid (arrowheads) indicative of acute obstruction although no stone was detected. Stone passed day after MRI examination was performed. F = fetal head.

View larger version (146K): [in a new window]   Fig. 9A. —22-year-old woman at 32 weeks' gestation who presented with elevated WBC and lower abdominal pain. Findings on previously obtained sonogram and results of urine dipstick analysis were normal. Axial (A) and sagittal (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/64; flip angle, 130°; matrix, 192 x 256; field of view, 32 cm; and slice thickness, 4 mm) show low signal intensity in nondependent portion of urinary bladder (arrows) consistent with air. Patient had not undergone instrumentation of urinary bladder and, therefore, urinary tract infection was suggested as cause. MRI findings led to performance of urine culture that documented presence of Escherichia coli.

View larger version (130K): [in a new window]   Fig. 9B. —22-year-old woman at 32 weeks' gestation who presented with elevated WBC and lower abdominal pain. Findings on previously obtained sonogram and results of urine dipstick analysis were normal. Axial (A) and sagittal (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/64; flip angle, 130°; matrix, 192 x 256; field of view, 32 cm; and slice thickness, 4 mm) show low signal intensity in nondependent portion of urinary bladder (arrows) consistent with air. Patient had not undergone instrumentation of urinary bladder and, therefore, urinary tract infection was suggested as cause. MRI findings led to performance of urine culture that documented presence of Escherichia coli.

View larger version (101K): [in a new window]   Fig. 10A. —31-year-old woman at 16 weeks' gestation who presented with severe right lower quadrant pain. Transabdominal sonogram obtained at level of right lower quadrant shows exophytic mass (arrows) originating from right lateral wall of uterus consistent with leiomyoma. Because of clinician's concern that severe right lower quadrant pain could be due to ovarian torsion or appendicitis, MRI was performed. P = placenta.

View larger version (172K): [in a new window]   Fig. 10B. —31-year-old woman at 16 weeks' gestation who presented with severe right lower quadrant pain. Coronal half-Fourier single-shot fast spin-echo image (TR/TE, single shot/62; flip angle, 130°; matrix, 192 x 256; field of view, 36 cm; and slice thickness, 4 mm) shows exophytic mass (arrow) originating from right lateral wall of uterus. Small amount of free fluid is noted surrounding mass (arrowheads). P = placenta.

View larger version (124K): [in a new window]   Fig. 10C. —31-year-old woman at 16 weeks' gestation who presented with severe right lower quadrant pain. Axial STIR image (4,400/72; inversion time, 175 msec; echo-train length, 33; matrix, 160 x 256; field of view, 22 cm; and slice thickness, 8 mm) shows diffuse heterogeneous increased signal intensity throughout mass (arrow) suggestive of edema. Free fluid (arrowheads) around fibroid is well depicted. Fibroid size remained unchanged throughout pregnancy.

View larger version (111K): [in a new window]   Fig. 11A. —Subchorionic hemorrhage in 36 year-old woman at 6 weeks' gestation. Axial half-Fourier single-shot fast spin-echo image (TR/TE, single shot/62; matrix, 192 x 256; field of view, 35 cm; and slice thickness, 4 mm) shows crescent-shaped area (arrow) of low signal intensity between gestational sac (G) and placenta, suggestive of small subchorionic hematoma.

View larger version (114K): [in a new window]   Fig. 11B. —Subchorionic hemorrhage in 36 year-old woman at 6 weeks' gestation. Axial 3D gradient-echo T1-weighted image (4.5/1.9; matrix, 130 x 256; field of view, 35 cm; and slice thickness, 2 mm after interpolation) confirms presence of subchorionic hemorrhage (arrow) with its typical high signal intensity.

View larger version (105K): [in a new window]   Fig. 12. —Abruption in patient at 30 weeks' gestation with placenta previa, bleeding, and pain. Because pain clinically indicates abruption, MRI was performed to identify extent of retroplacental clot. Immediate delivery was planned if large abruption was found. Sagittal T1-weighted MR image (TR/TE, 137/4.1; flip angle, 80°; field of view, 32 cm; matrix, 128 x 256; and acquisition time, 17 sec) shows small clot (arrow) above internal os (arrowhead), with most of placenta (P) well attached. Finding allowed patient to be managed expectantly, with delivery delayed for more than 4 weeks. P = placenta. Reprinted with permission from [11].

View larger version (149K): [in a new window]   Fig. 13A. —30-year-old woman at 27 weeks' gestation with acute right lower quadrant pain. MRI was performed to rule out acute appendicitis. Ovarian torsion was confirmed at laparoscopy. Reprinted with permission from [12]. Coronal (A) and sagittal (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/64; flip angle, 130°; matrix, 190 x 256; field of view, 40 cm; and slice thickness, 4 mm) show moderately enlarged right ovary (arrows) with multiple follicles predominantly located in periphery. Small amount of free fluid is noted around inferior aspect of right ovary. Normal appendix is located just inferior to ovary (arrowhead, A) and is looped on itself.

View larger version (112K): [in a new window]   Fig. 13B. —30-year-old woman at 27 weeks' gestation with acute right lower quadrant pain. MRI was performed to rule out acute appendicitis. Ovarian torsion was confirmed at laparoscopy. Reprinted with permission from [12]. Coronal (A) and sagittal (B) half-Fourier single-shot fast spin-echo images (TR/TE, single shot/64; flip angle, 130°; matrix, 190 x 256; field of view, 40 cm; and slice thickness, 4 mm) show moderately enlarged right ovary (arrows) with multiple follicles predominantly located in periphery. Small amount of free fluid is noted around inferior aspect of right ovary. Normal appendix is located just inferior to ovary (arrowhead, A) and is looped on itself.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati