Patients may present with pelvic pain or mass, or a clinician may find a mass incidentally during a physical exam or imaging. This clinical mind map is based upon pain, mass, or a combination of these two. Differential diagnoses of pelvic pain are listed with ectopic pregnancy on the top, which is a life-threatening diagnosis followed by the most common diagnoses such as dysmenorrhea, a few others arising from uterine and ovarian pathology, and then some arising from renal/bladder pathology. A clinician should also consider appendicitis and prostate pathology under applicable circumstances. Differential diagnoses listed under pain with or without mass should also be considered when evaluating patients even if the chief complain does not include mass. This is because patients may not be able to notice any mass, or a palpable mass may just not be present early on in the disease process. At times, a clinician may find a mass during an imaging procedure, and the patient may or may not be asymptomatic. These differentials are listed under pelvic mass and must be sought after under applicable circumstances.
Urgent/emergent situations must be addressed by reviewing vital signs and the patient’s appearance. Diagnoses which can give rise to urgent/emergent situations include ectopic pregnancy, severe pelvic inflammatory disease, and appendicitis. In addition, certain complications of ovarian cyst (rupture, severe infection), end stage colon cancer, prostatitis with septicemia, and end stage prostate/ovarian cancer may be life-threatening diagnoses if presented at late stages.
Weighing and removing anchor bias involves asking high yield questions which are based on the location and duration, focusing on medium yield questions, and making sure no diagnosis is overlooked.
Helpful mnemonics to remember three categories of diagnoses in this mind map are
1. DEEPO – CRAP (pelvic pain)
2. I female diagnosis, 1 male diagnosis and 2 diagnoses for both (pain or mass)
3. 3 Things women (mass)