Pathology of the Adnexa ch 45 Flashcards
PID is an inclusive term for all pelvic infections:
- Endometritis
- Salpingitis
- Hydrosalpinx
- Pyosalpinx
- Periovarian Inflammation
- Tubo-Ovarian Complex
- Tubo-Ovarian Abscess
PID and endometriosis are
diffuse disease processes of the female pelvic cavity.
Most commonly, PID is caused by
sexually transmitted diseases including gonorrhea and chlamydia.
Uncommonly, PID can also be caused by
ruptured appendix and peritonitis.
Sonography is of limited value during
acute PID, or early onset, when inflammatory changes have not yet begun to manifest.
In chronic PID, ultrasound can identify
dilated fallopian tubes (hydrosalpinx or pyosalpinx), an abscess, or complex intraperitoneal fluid.
PID occurs in
11% of young women during reproductive age, with peak incidence at 20 to
24 years
Risk factors of PID
- Early sexual contact
- Multiple sexual partners
- History of STI
- Previous history of PID
- Intrauterine Contraceptive Device (IUD)
Clinically, patients may present with
intense pelvic pain and tenderness described as dull and aching, with constant vaginal discharge.
Vaginitis is the
most common initial clinical presentation of the early stages of PID.
Other symptoms include
fever, pain in right upper abdomen, painful intercourse, irregular menstrual bleeding.
Endometritis sonograph
thickening or fluid in endometrium
Periovarian inflammation sonograph
enlarged ovaries with multiple cysts, indistinct margin
Salpingitis sonograph
nodular thickening, irregularity of tube with
diverticula
Pyosalpinx or hydrosalpinx sonograph
fluid-filled irregular fallopian tube with or without echoes
Tubo-ovarian abscess sonograph
complex mass with septations, irregular margins, internal echoes; usually in cul-de-sac
salpingitis
Inflammation of fallopian tube
salpingitis clinical
ranges from asymptomatic to pelvic fullness or discomfort
salpingitis sono
dilated tube, could be tortuous
Hydrosalpinx
Obstructed tube filled with serous secretions
Hydrosalpinx Occurs secondary to PID, endometriosis, or postoperative adhesions
Hydrosalpinx clinical
ranges from asymptomatic to pelvic fullness or discomfort
Hydrosalpinx sono
walls become thin due to dilatation, appearance of multi-cystic or fusiform mass, follow dilated tubes from uterine fundus, ampullary portion more dilated than interstitial part of tubes
Pyosalpinx
Retained pus in oviduct with inflammation
Pyosalpinx clinical
asymptomatic to pelvic fullness or discomfort, low-grade fever
Pyosalpinx sono
may appear as complex mass, pus within dilated tube very thick and echogenic
Tubo-Ovarian Abscess
Adhesive, edematous, inflamed serosa may further adhere to ovary and/or other peritoneal surfaces, which distorts anatomy.
Tubo-Ovarian Abscess as infection worsens,
periovarian adhesions may form.
Tubo-Ovarian Abscess Ovary cannot be separated from
inflamed dilated tube and called tubo-ovarian complex.
Tubo-Ovarian Abscess usually responds
well to antibiotic treatment without need for surgical drainage
Tubo-Ovarian Abscess serial ultrasound images during treatment allow
observation of resolution
Peritonitis
inflammation of the peritoneum (the serous membrane lining the abdominal cavity and covering the viscera)
Peritonitis if infectious process spreads to involve
bladder, ureter, bowel, and adnexal area, it becomes pelvic peritonitis.
Peritonitis caused by
infectious organisms that gain access by way of rupture or perforation of viscera or associated structures; via the female genital tract; by piercing abdominal wall; via bloodstream or lymphatic vessels; via surgical incisions; or by failure to practice antiseptic techniques during surgery
Sonographic Findings of Peritonitis
- Gas-forming bubbles
- Loculated areas of fluid within pelvis, paracolic gutters, mesenteric reflections
- Evaluation of space between right kidney and liver and left kidney and spleen where free fluid can form
TA or TVS guidance used for
aspiration of benign-appearing cysts
TVS drainage helpful
in TOAs; other pelvic abscesses, such as appendicitis and diverticulitis;
drainage of postoperative fluid collections
TVS also used in
obtaining biopsies for benign and malignant solid pelvic masses and to drain
recurrent malignant collections
