Learning objectives
Outline the pathway of ascending infection in pelvic inflammatory disease
Review the key imaging findings in pelvic inflammatory disease on all modalities (CT, MRI, ultrasound)
Describe common complications relating to pelvic inflammatory disease
Recognise mimics of pelvic inflammatory disease
Explain the role of interventional radiology in the management of pelvic inflammatory disease
Background
Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders in women, usually arising from spread of micro-organisms through the upper genital tract. It is common and is thought to account for up to 25% of emergency department attendances with gynaecological pain [1].
PID is usually the result of primary sexually transmitted infection (STI) ascending from the cervix to involve the uterus, fallopian tubes, ovaries, and ultimately the pelvis (Fig. 1). However, it can also occur secondary to spread of sepsis from elsewhere in the...
Findings and procedure details
Imaging Features
Imaging appearances vary depending on the extent of inflammation and presence of complications.
Early PID - uncomplicated or cervicitis/endometritis/oophoritis(Fig. 3)
Normal imagingdoes not exclude the diagnosis in the correct clinical scenario. When present, features are non-specific and are those of generalised pelvic inflammation [3], which include:
Broad ligament thickening
Pelvic free fluid
Pelvic fat stranding/heterogeneity
Reactive lymphadenopathy - particularly along the gonadal veins into the para-aortic region
Cervicitis - enlarged cervix with enhancement of the endocervical canal reflecting hyperaemia (Fig. 4)
Endometritis -...
Conclusion
Imaging has a limited role in uncomplicated PID, but is useful for evaluating the extent of pelvic inflammation and excluding complications.
The hallmark of complicated PID is an abnormal dilated fallopian tube with or without presence of a complex adnexal mass. Ultrasound is often nonspecific but is a useful first-line modality to assess for tubal dilatation and for adnexal masses. These can be better delineated on MRI and CT whilst also evaluating for differential diagnoses.
Interventional radiology also has a role in the management of...
Personal information and conflict of interest
M. Naik; London/UK - nothing to disclose M. T. Dawood; Stanmore/UK - nothing to disclose S. Sudderuddin; London/UK - nothing to disclose A. Rockall; London/UK - nothing to disclose V. Stewart; TW1 2HQ/UK - nothing to disclose N. Bharwani; London/UK - nothing to disclose
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