Imaging plays a crucial role in diagnosis and management of female patients presenting with acute pelvic pain. The combination of transabdominal and transvaginal US is the study of choice for initial evaluation of acute female pelvis. Colour, power and spectral Doppler provide additional information regarding associated vascularity which is of particular importance when evaluating for presence of ovarian torsion. US is very accurate in determining the specific cause of acute pelvic pain; common causes include ovarian cyst rupture, persistent corpus luteum cysts, ectopic pregnancy and endometriosis. US can reliably demonstrate the presence of a pyosalpinx or tubo-ovarian abscess complicating pelvic inflammatory disease. US is the initial modality for evaluating patients with a pelvic mass with or without suspected torsion. It can confirm the presence of the mass, establish its organ of origin and demonstrate its internal consistency (endometrioma versus dermoid versus complex/solid mass) as well as complications such as torsion, rupture, etc. US is also the first imaging modality for assessment of lost intra-uterine coil devices which can present with acute pelvic pain. CT may be performed after US to visualise the full extent of disease in severe cases of tubo-ovarian abscess. It is also indicated if clinical symptoms mimic appendicitis and is very useful in detection of post-operative complications. MRI is a problem-solving modality. It helps differentiate benign processes that necessitate specific immediate therapy from those that can be managed expectantly. This triage is particularly important in pregnant patients presenting with acute pelvic pain or indeterminate pelvic mass. Learning Objectives: