December 14, 2016

Imaging of Pelvic Inflammatory Disease, Part I

9 minutes

In this video lecture, we discuss the ultrasound and computed tomography (CT) appearance of pelvic inflammatory disease (PID).

Topics include:

Early findings of PID, including haziness of pelvic fat, salpingitis, oophoritis, and endometritis.

Importance of indentifying dilated fallopian tubes by the characteristic “C” or “S” shape that they exhibit, as well as the presence of the “cogwheel” sign.

Differentiating tubo-ovarian abscess (TOA) from tubo-ovarian complex (TOC), and the associated treatment implications.

Emphazing the typical posterior, dependent position of pyosalpinges and TOAs, as well as the associated anterior displacement of the broad ligament/mesosalpinx.

References:

Revzin MV, Mathur M, Dave HB, et al. Pelvic inflammatory disease: Multimodality imaging approach with clinical-pathologic correlation. Radiographics. 2016;36(5):1579-1596.

Kim D, Kim TU, Lee JW, et al. The perihepatic space: Comprehensive anatomy and CT features of pathologic conditions. Radiographics. 2007;27(1):129 –143.

Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: Spectrum of CT findings. Radiographics. 2002;22(4):785–801.

Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 2002;22(6):1327–1334.

Kaakaji Y, Nghiem HV, Nodell C, Winter. TC. Sonography of obstetric and gynecologic emergencies. Part II, Gynecologic emergencies. AJR Am J Roentgenol. 2000 Mar;174(3):651-656.

Kim MY, Rha SE, Oh SN, et al. MR imaging findings of hydrosalpinx: a comprehensive review. Radiographics. 2009;29(2):495-507.

Ha HK, Lim GY, Cha ES, et al. MR imaging of tubo-ovarian abscess. Acta Radiol. 1995;36(5):510-4.

Wilbur AC, Aizenstein RI, Napp TE. CT findings in tuboovarian abscess. AJR Am J Roentgenol. 1992;158(3):575-9.

Young ST, Paulson EK, McCann RL, Baker ME. Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess. AJR Am J Roentgenol. 1993;160(2):275-277.

Sandrasegaran K, Lall C, Rajesh A, Maglinte DT. Distinguishing gelatin bioabsorbable sponge and postoperative abdominal abscess on CT. AJR Am J Roentgenol. 2005;184(2):475-480.

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By Daniel J. Kowal, MD

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