Tannenbaum Melissa F, Lee Karen S, Yoon Se-Young, Levenson Robin B
From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.
Radiographics. 2025 Feb;45(2):e240101. doi: 10.1148/rg.240101.
Nonpregnant and pregnant women who present with acute pelvic pain can pose a diagnostic challenge in the emergency setting. The clinical presentation is often nonspecific, and the differential diagnosis may be very broad. These symptoms are often indications for pelvic US, which is the primary imaging modality when an obstetric or gynecologic cause is suspected. Interpretation of pelvic US may be challenging and a source of confusion and misinterpretation for radiologists. Additionally, cognitive biases in imaging interpretation can contribute to diagnostic errors. Cognitive biases represent systematic errors due to failure of the mental shortcuts that the brain subconsciously uses to produce quicker judgments. There are multiple different types of cognitive biases, all of which may lead to perceptual and interpretive errors. Familiarity with common and uncommon pelvic US findings in the setting of pelvic pain is imperative to assist with prompt and accurate diagnosis. Awareness of potential biases when interpreting pelvic US findings further helps hone the interpretation. The authors illustrate the imaging findings in several peer learning cases of nonpregnant and first-trimester pregnant patients who presented with acute pelvic pain in the emergency setting. Several nonobstetric and nongynecologic causes of acute pelvic pain are included for which pelvic US was the first imaging modality used in diagnosis. Diagnostic errors and cognitive biases in interpretation related to these cases are highlighted. The radiologist's awareness of potential cognitive biases in image interpretation may help to refine the differential diagnosis and mitigate errors. RSNA, 2025 Supplemental material is available for this article.
出现急性盆腔疼痛的非孕妇和孕妇在急诊环境中可能构成诊断挑战。临床表现往往不具有特异性，鉴别诊断范围可能非常广泛。这些症状通常提示需要进行盆腔超声检查，当怀疑是产科或妇科原因时，盆腔超声是主要的成像方式。盆腔超声的解读可能具有挑战性，对放射科医生来说可能是困惑和误解的来源。此外，成像解读中的认知偏差可能导致诊断错误。认知偏差是由于大脑下意识用于做出更快判断的思维捷径失效而产生的系统性错误。存在多种不同类型的认知偏差，所有这些都可能导致感知和解读错误。熟悉盆腔疼痛情况下常见和不常见的盆腔超声表现对于协助快速准确诊断至关重要。在解读盆腔超声结果时意识到潜在偏差有助于进一步优化解读。作者在几个同伴学习案例中展示了非孕妇和孕早期孕妇在急诊环境中出现急性盆腔疼痛的成像结果。包括了几种急性盆腔疼痛的非产科和非妇科病因，盆腔超声是诊断中首先使用的成像方式。突出了与这些病例相关的诊断错误和解读中的认知偏差。放射科医生对图像解读中潜在认知偏差的认识可能有助于完善鉴别诊断并减少错误。RSNA，2025 本文有补充材料。
