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Pelvic Inflammatory Disease
Akram M. Shaaban, MBBCh; Maryam Rezvani, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Pelvic inflammatory disease (PID)
              • Tuboovarian abscess (TOA)
            • Definitions

              • PID: Collective term for acute pyogenic inflammatory disease of upper female genital tract, encompassing inflammation of endometrium (endometritis), cervix (cervicitis), fallopian tubes (salpingitis), ovaries (oophoritis), and peritoneal cavity (peritonitis)
              • TOA: Severe end of PID spectrum resulting in destruction of normal structures with formation of inflammatory mass encompassing both fallopian tube and ovary

            Imaging

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      Differential Diagnosis

                      • Other Causes of Pelvic Infection

                        • Other Causes of Acute Pelvic Pain

                          • Other Causes of Distended Fallopian Tube

                            • Other Causes of Adnexal Mass

                              Pathology

                              • General Features

                                • Microscopic 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. Czeyda-Pommersheim F et al: MRI in pelvic inflammatory disease: a pictorial review. Abdom Radiol (NY). 42(3):935-50, 2017
                                            3. Spain J et al: MDCT of pelvic inflammatory disease: a review of the pathophysiology, gamut of imaging findings, and treatment. Emerg Radiol. 24(1):87-93, 2017
                                            4. Revzin MV et al: Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics. 36(5):1579-96, 2016
                                            5. Lee MH et al: CT findings of acute pelvic inflammatory disease. Abdom Imaging. 39(6):1350-5, 2014
                                            6. 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
                                            7. Zhao WH et al: Pelvic inflammatory disease: a retrospective clinical analysis of 1,922 cases in North China. Gynecol Obstet Invest. 77(3):169-75, 2014
                                            8. Greenstein Y et al: Tuboovarian abscess. Factors associated with operative intervention after failed antibiotic therapy. J Reprod Med. 58(3-4):101-6, 2013
                                            9. Mitchell C et al: Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 27(4):793-809, 2013
                                            10. Nakayama K et al: Surgical treatment outcomes of serious chronic tubo-ovarian abscess: a single-center series of 20 cases. Clin Exp Obstet Gynecol. 40(3):377-80, 2013
                                            11. Romosan G et al: Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study. Hum Reprod. 28(6):1569-79, 2013
                                            12. Chappell CA et al: Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 55(4):893-903, 2012
                                            13. Lewiss RE et al: Sonographic cervical motion tenderness: a sign found in a patient with pelvic inflammatory disease. Crit Ultrasound J. 4(1):20, 2012
                                            14. Thomassin-Naggara I et al: Gynecological pelvic infection: what is the role of imaging? Diagn Interv Imaging. 93(6):491-9, 2012
                                            15. Cicchiello LA et al: Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 38(1):85-114, viii, 2011
                                            16. Levenson RB et al: Image-guided drainage of tuboovarian abscesses of gastrointestinal or genitourinary origin: a retrospective analysis. J Vasc Interv Radiol. 22(5):678-86, 2011
                                            17. Rezvani M et al: Fallopian tube disease in the nonpregnant patient. Radiographics. 31(2):527-48, 2011
                                            18. Banikarim C et al: Pelvic inflammatory disease in adolescents. Semin Pediatr Infect Dis. 16(3):175-80, 2005
                                            19. Barrett S et al: A review on pelvic inflammatory disease. Int J STD AIDS. 16(11):715-20; quiz 721, 2005
                                            20. Banikarim C et al: Pelvic inflammatory disease in adolescents. Adolesc Med Clin. 15(2):273-85, viii, 2004
                                            21. Horrow MM: Ultrasound of pelvic inflammatory disease. Ultrasound Q. 20(4):171-9, 2004
                                            22. Krivak TC et al: Tubo-ovarian abscess: diagnosis, medical and surgical management. Compr Ther. 30(2):93-100, 2004
                                            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

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Pelvic inflammatory disease (PID)
                                                        • Tuboovarian abscess (TOA)
                                                      • Definitions

                                                        • PID: Collective term for acute pyogenic inflammatory disease of upper female genital tract, encompassing inflammation of endometrium (endometritis), cervix (cervicitis), fallopian tubes (salpingitis), ovaries (oophoritis), and peritoneal cavity (peritonitis)
                                                        • TOA: Severe end of PID spectrum resulting in destruction of normal structures with formation of inflammatory mass encompassing both fallopian tube and ovary

                                                      Imaging

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                Differential Diagnosis

                                                                • Other Causes of Pelvic Infection

                                                                  • Other Causes of Acute Pelvic Pain

                                                                    • Other Causes of Distended Fallopian Tube

                                                                      • Other Causes of Adnexal Mass

                                                                        Pathology

                                                                        • General Features

                                                                          • Microscopic 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. Czeyda-Pommersheim F et al: MRI in pelvic inflammatory disease: a pictorial review. Abdom Radiol (NY). 42(3):935-50, 2017
                                                                                      3. Spain J et al: MDCT of pelvic inflammatory disease: a review of the pathophysiology, gamut of imaging findings, and treatment. Emerg Radiol. 24(1):87-93, 2017
                                                                                      4. Revzin MV et al: Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics. 36(5):1579-96, 2016
                                                                                      5. Lee MH et al: CT findings of acute pelvic inflammatory disease. Abdom Imaging. 39(6):1350-5, 2014
                                                                                      6. 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
                                                                                      7. Zhao WH et al: Pelvic inflammatory disease: a retrospective clinical analysis of 1,922 cases in North China. Gynecol Obstet Invest. 77(3):169-75, 2014
                                                                                      8. Greenstein Y et al: Tuboovarian abscess. Factors associated with operative intervention after failed antibiotic therapy. J Reprod Med. 58(3-4):101-6, 2013
                                                                                      9. Mitchell C et al: Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 27(4):793-809, 2013
                                                                                      10. Nakayama K et al: Surgical treatment outcomes of serious chronic tubo-ovarian abscess: a single-center series of 20 cases. Clin Exp Obstet Gynecol. 40(3):377-80, 2013
                                                                                      11. Romosan G et al: Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study. Hum Reprod. 28(6):1569-79, 2013
                                                                                      12. Chappell CA et al: Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 55(4):893-903, 2012
                                                                                      13. Lewiss RE et al: Sonographic cervical motion tenderness: a sign found in a patient with pelvic inflammatory disease. Crit Ultrasound J. 4(1):20, 2012
                                                                                      14. Thomassin-Naggara I et al: Gynecological pelvic infection: what is the role of imaging? Diagn Interv Imaging. 93(6):491-9, 2012
                                                                                      15. Cicchiello LA et al: Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 38(1):85-114, viii, 2011
                                                                                      16. Levenson RB et al: Image-guided drainage of tuboovarian abscesses of gastrointestinal or genitourinary origin: a retrospective analysis. J Vasc Interv Radiol. 22(5):678-86, 2011
                                                                                      17. Rezvani M et al: Fallopian tube disease in the nonpregnant patient. Radiographics. 31(2):527-48, 2011
                                                                                      18. Banikarim C et al: Pelvic inflammatory disease in adolescents. Semin Pediatr Infect Dis. 16(3):175-80, 2005
                                                                                      19. Barrett S et al: A review on pelvic inflammatory disease. Int J STD AIDS. 16(11):715-20; quiz 721, 2005
                                                                                      20. Banikarim C et al: Pelvic inflammatory disease in adolescents. Adolesc Med Clin. 15(2):273-85, viii, 2004
                                                                                      21. Horrow MM: Ultrasound of pelvic inflammatory disease. Ultrasound Q. 20(4):171-9, 2004
                                                                                      22. Krivak TC et al: Tubo-ovarian abscess: diagnosis, medical and surgical management. Compr Ther. 30(2):93-100, 2004