Key content Tubo‐ovarian abscesses represent a severe form of pelvic inflammatory disease and carry high morbidity. Diagnosis is made by combining the clinical picture (fever, pelvic pain and pelvic adnexal mass) with raised inflammatory markers and radiological findings demonstrating an abscess. Initial management with intravenous antibiotics may not be successful. Surgical intervention may be indicated but the optimal timing is not clear and image‐guided drainage can be a possible alternative to surgery. Surgery may be conservative or involve pelvic clearance and will depend on the clinical situation. Learning objectives To be able to recognise and initiate prompt treatment of pelvic inflammatory disease and tubo‐ovarian abscesses. To understand appropriate antibiotic treatment and/or radiological drainage. To be able to identify indications for timely surgical intervention and explore the optimal surgical approach of laparoscopic versus open surgery. Ethical issues Delays in treatment may have adverse effects on future fertility. Who is appropriate for fertility‐preserving treatment?

Purpose: To investigate the water diffusion tensor properties of ex vivo tissue in the fibroid uterus, including the influence of degeneration, and the relevance of the principal eigenvector orientation to the underlying tissue structure. Materials and Methods:Following hysterectomy, high-resolution structural T 2 -weighted and diffusion tensor magnetic resonance imaging (DT-MRI) were performed on nine uteri at 7 T. Mean diffusivity (MD), fractional anisotropy (FA), and principal eigenvector orientation were measured in myometrium and in myxoid and dense tissue in fibroids. Imaging data and measurements of water diffusion parameters were compared with histopathology findings. Results:The nine uteri yielded 23 fibroids. MD was 50% higher in regions of myxoid degeneration compared to dense fibroid tissue (P ¼ 0.001), while myometrium was intermediate in value (dense fibroid tissue, P ¼ 0.15; myxoid degeneration, P ¼ 0.23). FA was lower in dense fibroid tissue than in myometrium (P ¼ 3 Â 10 À5 ), but higher than in myxoid tissue (P ¼ 0.003). Principal eigenvector orientation corresponded qualitatively with that of uterine smooth muscle fibers. Conclusion:The water diffusion tensor measured ex vivo in the fibroid uterus is a sensitive probe of tissue type, myxoid degeneration, and morphology.

The aim of our study was to develop a reliable technique for measuring volume of the fibroid uterus using Magnetic Resonance Imaging. We applied the Cavalieri method and standard calliper technique to measure the volume of the uterus and largest fibroid in 26 patients, and results were compared with "gold-standard" planimetry measurements. We found Cavalieri measurements to be unbiased, while calliper measurements systematically underestimated uterine volume (- 13.2%, P < 10(-5)) and had greater variance. Repeatability was similar for the 2 techniques (standard deviation [SD] = 4.0%-6.9%). Reproducibility of Cavalieri measurements was higher for measurement of uterine (SD = 9.0%) than fibroid volume (SD = 19.1%), whereas the reproducibility of calliper measurements was higher for fibroid (SD = 9.1%) than uterine volume (SD = 15.9%). The additional measurement time for the Cavalieri method was approximately 1 to 2 minutes. In conclusion, the Cavalieri method permits more accurate measurement of uterine and fibroid volumes and is suitable for application in both clinical practice and scientific research.