Radiology Lectures | Radquarters

Imaging of Pelvic Inflammatory Disease, Part I

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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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      Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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