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Type:
Educational Exhibit
Keywords:
Genital / Reproductive system female, Pelvis, Abdomen, CT, Ultrasound, Diagnostic procedure, Education and training, Pathology
Authors:
E. Matos, A. T. Almeida, D. Castelo; Vila Nova de Gaia/PT
DOI:
10.1594/ecr2015/C-2451
Findings and procedure details
The spectrum of ultrasonographic features is thoroughly known and amply described.
The opposite is seen with respect to TDM ones.
At an advanced and progressed staged of the disease TDM findings are easy to recognize and appear as tubo-ovarian and pelvic abscesses.
It is important to recognize the possible TDM findings of special significance,
mainly the early and subtle ones,
which frequently go unnoticed and unrecognized.
At an early stage of the disease these are reflected by edema with densification of the pelvic adipose planes,
obscuration of the normal fascial planes and thickening of the utero-sacral ligaments,
with or without mild signs of oophoritis,
salpingitis,
endometritis and/or cervicitis and with or without accumulation of endocavitary,
tubal and/or pelvic fluid.
At a subsequent stage,
these signs are more pronounced and the fluid is complex,
culminating in the formation of visible tubo-ovarian or pelvic abscesses.
A promptly and timely diagnosis and treatment are extremely important,
attending to the possibility of serious consequences of the disease.
Deserving special mention are ectopic pregnancy,
infertility and chronic pelvic pain,
which are due to fibrosis,
damage and occlusion of involved structures - particularly fallopian tubes - seen at a chronic stage.
Contiguous inflammatory involvement of the large and small bowel and ureters may be a cause of functional or mechanical obstruction.
Other possible complications are Fitz-Hugh-Curtis syndrome and ovarian vein thrombosis.
Attending to the fact that PID generally manifests with unspecific signs and symptoms several diagnosis hypothesis can be set in these clinical scenario.
From a clinical and radiological perspective,
PID must be differentiated from other possible mimicking conditions.
Deserving mention are other inflammatory conditions as ileo-colitis,
acute appendicitis,
diverticulitis and acute epiploic appendagitis; and pathologies with a different nature as ectopic pregnancy and neoplastic lesions,
mainly those of an intestinal origin,
like those affecting the colon and rectum.