Background: Female patients with acute abdomino/pelvic symptoms are a relatively common problem in the Emergency Department. The diagnostic approach to them is based first on clinical ground (which symptoms, which age), then on lab tests (especially a serum beta-hCG assessment) and imaging. Content: Ultrasound (US) is the preferred imaging technique when clinical findings suggest an acute pelvic condition; however, symptoms are not always specific and also computed tomography (CT) and magnetic resonance imaging (MRI) are frequently employed. Although, ideally, imaging examinations should be performed with full knowledge of both clinical and laboratory situation, this is not always the case, since some lab tests are time-consuming and emergency studies have to be performed before knowing their results. Conclusion: A large variety of conditions may cause acute pelvic symptoms but the most common and ”dangerous” ones are adnexal torsion, pelvic inflammatory disease (PID) and ectopic pregnancy. This presentation will describe the imaging findings observed in them and will underline the need for integration of clinical information with imaging findings to reach the correct diagnosis.