Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation

Abstract

Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.

Origin and microenvironment contribute to the sexually dimorphic phenotype and function of peritoneal macrophages

“…Indeed C1q , C3 , and C4b , as well as Cfb, which encodes factor B and is essential for the alternative pathway of complement fixation during S.pneumoniae infection, were also all expressed more highly by female peritoneal macrophages. We propose that this heightened barrier function in the female peritoneum may have evolved to mitigate the risk of sexually transmitted infection disseminating from the lower female reproductive tract 68 or to protect against puerperal peritonitis. Our findings also have wider implications for understanding peritoneal macrophage behaviour following a local mechanical or inflammatory insult, when tissue resident macrophages may be replaced by monocyte-derived cells that may require prolonged residence in the tissue before acquiring the full profile of resident macrophages with protective functions 55, 69–71 .…”

Hydrosalpinx in patients with hysterectomy without salpingo-oophorectomy referred for pelvic magnetic resonance imaging

“…Hydrosalpinx was identified as a tubular cystic structure adjacent to the ovary (Figs. 1 and 2) and the use of orthogonal planes of T2weighted imaging, which is routinely acquired as part of the female pelvis MRI imaging protocol, was helpful in identifying the tubular nature of the dilated Fallopian tubes [15,16]. The prevalence of hydrosalpinx in patients with ovarian-sparing hysterectomy was 18% (14 of 76 patients; kappa score of 0.8).…”

Dolor abdominal: causas poco frecuentes

“…La inflamación de la capsula hepática puede producir áreas de alteración variable de la perfusión subcapsular o periportal, igualmente se puede observar líquido y rarefacción de la grasa en la gotiera parietocólica derecha, septos peritoneales, fluido perihepático loculado y engrosamiento de la pared vesicular. [17][18][19] El aislamiento de Neiseria Gonorreae o Clamidia Tracomatis en el estudio del fluido vaginal sumado a las imágenes clásicas descriptas es suficiente para confirmar el diagnóstico. 17…”

“…[17][18][19] El aislamiento de Neiseria Gonorreae o Clamidia Tracomatis en el estudio del fluido vaginal sumado a las imágenes clásicas descriptas es suficiente para confirmar el diagnóstico. 17…”