The purpose of this study is to highlight the role of multidetector CT (MDCT) in emergency radiology as a useful tool in the diagnosis and management of acute female pelvic disease and to describe key radiologic signs to improve differential diagnosis. We restrospectively reviewed MDCT findings of acute pelvic disease and its mimics in women reporting to the emergency room at our institution from December 2006 to August 2008. We describe MDCT findings of gynecologic and obstetric disorders such as hemorrhagic ovarian cysts, ovarian torsion, pelvic inflammatory disease, ruptured ectopic pregnancy, intravascular leiomyomatosis, blunt maternal trauma, and postpartum and post-cesarean section complications. We also briefly review gastrointestinal tract entities that may mimic these conditions. Although ultrasound is the imaging modality of choice for the evaluation of female pelvic pain, the role of MDCT remains essential in the management of patients in which gynecologic exploration is not diagnostic or undone since it is not the initial suspicion.