Learning objectives
· To review the appearance of pelvic inflammatory disease (PID) on different modalities including: ultrasound,
CT and MRI.
· Understand the aetiology and different presentations of PID.
· Understand the role of radiology in the management of PID and diagnosis of complications.
Background
The term PID includes inflammation of the uterus,
fallopian tubes and ovaries and is a common cause of abdominal pain in young women.
PID has significant acute and chronic morbidity and associated financial implications.
In the UK,
latest figures put the diagnosis of PID in 16-44 year olds at 176/100,000 in the general practice setting and 241/100,00 in the hospital setting per year (2011) [1,
2].
PID diagnosis rates were most frequent in the 20-24 year old age group within the general practice (GP) setting...
Findings and procedure details
1.
Acute complications
Acute Cervicitis and Endometritis
One of the most common presentations of primary PID is cervicitis or endometritis.
Infection can also occur postpartum from vaginal delivery(3%) or post-caesarean section (85%),
usually from group B streptococcus.
Imaging is not frequently needed but if there is concern of possible complications (e.g.
retained products of conception Fig. 2) or presentation is atypical with a broad differential,
US,
CT or MRI can be used to aid diagnosis.
Imaging features of acute cervicitis and endometritis may be subtle...
Conclusion
PID is a common condition.
There has been little change in the incidence of presentation to hospital and therefore clinicians should be alert to this diagnosis.
Accurate history taking and clinical examination are crucial.
However,
radiology has a central role in the accurate diagnosis of PID and radiologists should be aware of the many different appearances on all imaging modalities (Table 3).
Radiology also has a role in the management of PID,
with ultrasound-guided drainage via a trans-abdominal or trans-vaginal route.
References
1.
British Association for Sexual Health and HIV Clinical Effectiveness Group.
UK national guidline for the management of pelvic inflammatory disease 2011.
British Association for Sexual Health and HIV 2011,
p.
18.
2.
Rates of pelvic inflammatory disease in England,
2000-2013.
Ref: HPR 9(22) Public Health England 23 June 2015.
https://www.gov.uk/government/publications/pelvic-inflammatory-disease-in-england
3.
Ross J,
Guaschino S,
Cusini M,
Jensen J.
2017 European guideline for the management of pelvic inflammatory disease.
Int J STD AIDS.
2017 Jan 1
4. Czeyda-Pommersheim F,
Kalb B,
Costello J,
Liau...