Acute Female pelvic pain is one the common causes of referral to emergency ward. It has many ethiologies of either Gynaecological or non gynecological causes including normal ovulation, haemorrhagic/ruptured ovarian cyst, Tumour, infarction (leiomyoma), Ovarian torsion, ectopic pregnancy, Tubo-ovarian abscess/PID, Endometriosis, …etc. It also has non-gynaecological causes such as renal stones, appendicitis, diverticulitis, IBD or trauma. It is important to make the precise diagnosis in proper time as some of them are potentially vital and any delay on management may have irreversible sequellas. In this article we discuss the role of US, CT and MRI in evaluation of Acute female pelvis, and how to reach an accurate diagnosis based on patients demographics, Clinical scenario and anatomical abnormality. Also we discuss about the added value of MRI in pregnant patients and pearls and pitfalls of imaging of the Acute female pelvis.