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Clinical Outcome in Female Patients with Pelvic Pain and Normal Pelvic US Findings¹

¹ From the Department of Radiology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756 (R.D.H., S.R.H.), and Dartmouth College, Hanover, NH (A.P.). Received June 1, 1999; revision requested July 26; revision received November 1; accepted November 24. A.P. supported in part by a grant from the Dartmouth Women in Science Project, Dartmouth College. Address correspondence to R.D.H. (e-mail: robert.harris@hitchcock.org).

PURPOSE: To understand the clinical outcome in patients with pelvic pain and negative pelvic ultrasonographic (US) findings.

MATERIALS AND METHODS: Data from 86 female patients with pelvic pain and normal pelvic US findings seen in a US section over a 15-month period were evaluated 6–21 months after US. Medical chart review follow-up was available in 86 patients, and telephone interview follow-up was conducted in 85 patients. We collected data on the outcome of pain; subsequent imaging, treatment, and surgery; and the duration of pain before US.

RESULTS: Pelvic pain improved or resolved in 66 (77%) of the 86 patients. In the group with acute or subacute pain (duration 6 months), 62 (86%) of the 72 patients (19 with acute pain and 53 with subacute pain) had improvement or resolution of symptoms. In the group with chronic pain (duration > 6 months), seven (50%) of the 14 patients had improved symptoms. Further imaging (13 studies) was performed in nine patients: Twelve studies were normal, and one computed tomographic scan (1 month after the first US examination) showed diverticulitis. Eleven patients underwent 19 surgical procedures (endometrial sampling, hysteroscopy, laparoscopy, or hysterectomy). Four demonstrated clinically important disease (endometriosis and pelvic varices, endometriosis, adenomyosis, or pelvic adhesions).

CONCLUSION: The majority of patients with pelvic pain and normal pelvic US findings had improvement or resolution of their symptoms, and those with acute or subacute pain were more likely to report improvement or resolution of pain than those with chronic pain. The yield of further imaging studies was low, and disease was identified in a minority of patients.

Index terms: Endometriosis, 85.3192 • Pelvic organs, abnormalities, 85.31, 85.3192, 85.80 • Pelvic organs, diseases, 85.31, 85.3192, 85.80 • Pelvic organs, US, 85.1298 • Radiology and radiologists, outcomes studies • Ultrasound (US), utilization

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