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Ultrasound
Diagnosis
Female Pelvis
Non-Ovarian Cystic Masses
Pelvic Inflammatory Disease
Pelvic Inflammatory Disease
Margarita V. Revzin, MD, MS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Pelvic inflammatory disease (PID)
                  • Spectrum of disease, including cervicitis, endometritis, salpingitis, oophoritis, tuboovarian abscess (TOA), and peritonitis
                  • Usually STD involving organism, such as Chlamydia trachomatis or Neisseria gonorrhoeae but can also be polymicrobial; ascending infection
                  • Can also occur from extension of inflammation from adjacent organs, such as appendicitis, diverticulitis, and colitis
                • Pyosalpinx
                  • Tube distended with pus
                • Tuboovarian complex (TOC)
                  • Pyosalpinx cannot be separated from ipsilateral ovary; however, ovarian parenchyma is preserved
                • TOA
                  • Abscess involving tube and ipsilateral ovary
                  • Separate ovary is no longer distinguishable; no normal ovarian parenchyma and follicles are seen

              IMAGING

              • General Features

                • Ultrasonographic Findings

                  • CT Findings

                    • Imaging Recommendations

                      • MR Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Revzin MV et al: Imaging evaluation of fallopian tubes and related disease: a primer for radiologists. Radiographics. 40(5):1473-501, 2020
                                      2. Revzin MV et al: Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics. 36(5):1579-96, 2016
                                      3. CDC: Sexually Transmitted Diseases Treatment Guidelines, 2015. http://www.cdc.gov/std/tg2015/tg-2015-print.pdf
                                      4. Romosan G et al: The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature. Arch Gynecol Obstet. 289(4):705-14, 2014
                                      5. Kaproth-Joslin K et al: Imaging of female infertility: a pictorial guide to the hysterosalpingography, ultrasonography, and magnetic resonance imaging findings of the congenital and acquired causes of female infertility. Radiol Clin North Am. 51(6):967-81, 2013
                                      6. Romosan G et al: Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study. Hum Reprod. 28(6):1569-79, 2013
                                      7. Andreotti RF et al: Sonographic evaluation of acute pelvic pain. J Ultrasound Med. 31(11):1713-8, 2012
                                      8. Chappell CA et al: Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 55(4):893-903, 2012
                                      9. Roche O et al: Radiological appearances of gynaecological emergencies. Insights Imaging. 3(3):265-75, 2012
                                      10. Rezvani M et al: Fallopian tube disease in the nonpregnant patient. Radiographics. 31(2):527-48, 2011
                                      11. Moyle PL et al: Nonovarian cystic lesions of the pelvis. Radiographics. 30(4):921-38, 2010
                                      12. Kim JY et al: Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID. Abdom Imaging. 34(6):737-42, 2009
                                      13. Adhikari S et al: Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. J Emerg Med. 34(4):429-33, 2008
                                      14. Halperin R et al: Predictors of tuboovarian abscess in acute pelvic inflammatory disease. J Reprod Med. 53(1):40-4, 2008
                                      15. Potter AW et al: US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 28(6):1645-59, 2008
                                      16. Piscaglia F et al: Fitz-Hugh-Curtis-syndrome mimicking acute cholecystitis: value of new ultrasound findings in the differential diagnosis. Ultraschall Med. 26(3):227-30, 2005
                                      17. Horrow MM: Ultrasound of pelvic inflammatory disease. Ultrasound Q. 20(4):171-9, 2004
                                      18. Dohke M et al: Comprehensive MR imaging of acute gynecologic diseases. Radiographics. 20:1551-66, 2000
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Pelvic inflammatory disease (PID)
                                                      • Spectrum of disease, including cervicitis, endometritis, salpingitis, oophoritis, tuboovarian abscess (TOA), and peritonitis
                                                      • Usually STD involving organism, such as Chlamydia trachomatis or Neisseria gonorrhoeae but can also be polymicrobial; ascending infection
                                                      • Can also occur from extension of inflammation from adjacent organs, such as appendicitis, diverticulitis, and colitis
                                                    • Pyosalpinx
                                                      • Tube distended with pus
                                                    • Tuboovarian complex (TOC)
                                                      • Pyosalpinx cannot be separated from ipsilateral ovary; however, ovarian parenchyma is preserved
                                                    • TOA
                                                      • Abscess involving tube and ipsilateral ovary
                                                      • Separate ovary is no longer distinguishable; no normal ovarian parenchyma and follicles are seen

                                                  IMAGING

                                                  • General Features

                                                    • Ultrasonographic Findings

                                                      • CT Findings

                                                        • Imaging Recommendations

                                                          • MR Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Revzin MV et al: Imaging evaluation of fallopian tubes and related disease: a primer for radiologists. Radiographics. 40(5):1473-501, 2020
                                                                          2. Revzin MV et al: Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics. 36(5):1579-96, 2016
                                                                          3. CDC: Sexually Transmitted Diseases Treatment Guidelines, 2015. http://www.cdc.gov/std/tg2015/tg-2015-print.pdf
                                                                          4. Romosan G et al: The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature. Arch Gynecol Obstet. 289(4):705-14, 2014
                                                                          5. Kaproth-Joslin K et al: Imaging of female infertility: a pictorial guide to the hysterosalpingography, ultrasonography, and magnetic resonance imaging findings of the congenital and acquired causes of female infertility. Radiol Clin North Am. 51(6):967-81, 2013
                                                                          6. Romosan G et al: Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study. Hum Reprod. 28(6):1569-79, 2013
                                                                          7. Andreotti RF et al: Sonographic evaluation of acute pelvic pain. J Ultrasound Med. 31(11):1713-8, 2012
                                                                          8. Chappell CA et al: Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 55(4):893-903, 2012
                                                                          9. Roche O et al: Radiological appearances of gynaecological emergencies. Insights Imaging. 3(3):265-75, 2012
                                                                          10. Rezvani M et al: Fallopian tube disease in the nonpregnant patient. Radiographics. 31(2):527-48, 2011
                                                                          11. Moyle PL et al: Nonovarian cystic lesions of the pelvis. Radiographics. 30(4):921-38, 2010
                                                                          12. Kim JY et al: Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID. Abdom Imaging. 34(6):737-42, 2009
                                                                          13. Adhikari S et al: Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. J Emerg Med. 34(4):429-33, 2008
                                                                          14. Halperin R et al: Predictors of tuboovarian abscess in acute pelvic inflammatory disease. J Reprod Med. 53(1):40-4, 2008
                                                                          15. Potter AW et al: US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 28(6):1645-59, 2008
                                                                          16. Piscaglia F et al: Fitz-Hugh-Curtis-syndrome mimicking acute cholecystitis: value of new ultrasound findings in the differential diagnosis. Ultraschall Med. 26(3):227-30, 2005
                                                                          17. Horrow MM: Ultrasound of pelvic inflammatory disease. Ultrasound Q. 20(4):171-9, 2004
                                                                          18. Dohke M et al: Comprehensive MR imaging of acute gynecologic diseases. Radiographics. 20:1551-66, 2000