Type:
Educational Exhibit
Keywords:
Genitourinary, Abdomen, Genital / Reproductive system female, Pelvis, CT, MR, Ultrasound, Drainage, Education and training, Pathology, Not applicable
Authors:
M. Naik1, M. T. Dawood2, S. Sudderuddin1, A. G. Rockall1, V. Stewart3, N. Bharwani1; 1London/UK, 2STANMORE/UK, 3TW1 2HQ/UK
DOI:
10.26044/ecr2020/C-15212
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 pelvis, for instance from diverticulitis or appendicitis, or be transmitted via lymphatics (particularly when intrauterine devices are present) or blood (tuberculosis).
Fig. 1: Pathway of Ascending Infection (Primary PID)
Epidemiology
PID usually affects young sexually active women. A history of instrumentation and immunosuppression increase risk. Causative organisms include N. gonorrhoea and C. trachomatis. Polymicrobial infection is common.
Clinical Presentation and Diagnostic Workup
Patients may be asymptomatic but typical symptoms include fever and pelvic pain (Fig. 2).
Fig. 2: Diagnostic Workup
The diagnosis is primarily clinical, but imaging has a role where diagnosis is uncertain or to assess for complications [2].