Acute pelvic inflammatory disease: Diagnostic performance of CT

Jung, Sung Il; Kim, Young Jun; Park, Hee Sun; Jeon, Hae Jeong; Jeong, Kyung Ah

doi:10.1111/j.1447-0756.2010.01380.x

Cited by 21 publications

(17 citation statements)

References 34 publications

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“…Pelvic fat haziness refers to increased attenuation of the pelvic fat when compared with retroperitoneal fat. Pelvic fat haziness is one of the most sensitive findings of acute PID and is seen in as many as 65% of patients (10,11). Pelvic peritonitis refers to increased attenuation and marked stranding of the pelvic fat with peritoneal enhancement.…”

Section: Overview Of General Ct Findings Of Pidmentioning

confidence: 99%

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

Revzin¹,

Mathur²,

Dave³

et al. 2016

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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.

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Section: Overview Of General Ct Findings Of Pidmentioning

confidence: 99%

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

Revzin¹,

Mathur²,

Dave³

et al. 2016

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125

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“…Our understanding is that tubal thickening could be a thickened pedicle without a whirl sign or thickened fallopian tube itself. Because tubal thickening may also be seen in diseases other than adnexal torsion such as pelvic inflammatory disease [ 19 , 20 ], we think tubal thickening itself cannot be a specific finding of adnexal torsion ( Fig 5 ) and needs ancillary findings to be a specific finding of adnexal torsion (Figs 2 – 4 ).…”

Section: Discussionmentioning

confidence: 99%

CT findings of adnexal torsion: A matched case-control study

et al. 2018

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ObjectiveThe purpose of our study was to assess computed tomographic (CT) findings of adnexal torsion through a matched case-control analysis.Materials and methodsThis retrospective, single-institution case-control study included 43 women with adnexal torsion and 43 age- and ovarian mass-matched control women. CT images were evaluated independently by two readers for the following: prominent peripheral follicles, uterine deviation, thickened pedicles, a whirl sign, and a navel sign. Comparisons of CT findings were performed using the Chi square test and receiver operating characteristic (ROC) curves were obtained to assess the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared by using a Delong test.ResultsThe CT findings significant for adnexal torsion were uterine deviation toward the side of the affected ovary (P = < .01 for reader 1 and P = .02 for reader 2) and thickened pedicles with ancillary findings including a whirl sign, a navel sign, and uterine deviation facing thickened pedicles (P < .01 for both readers). Thickened pedicles with ancillary findings had the highest diagnostic accuracy, as measured with ROC curves (AUC, 0.86 in reader 1 and 0.85 in reader 2). Combining uterine deviation toward the side of the affected ovary with thickened pedicles with ancillary findings did not increase the performance relative to that of thickened pedicles with ancillary findings alone.ConclusionsThickened pedicles with ancillary findings including a whirl sign, a navel sign, and uterine deviation facing thickened pedicles could be helpful for the diagnosis of adnexal torsion.

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“…Moreover, from a clinical point of view, chronic inflammation caused by C. trachomatis infection is often accompanied by extensive remodelling of urogenital tissues and accumulation of cervicodorsal fat [17,18]. Chronic pelvic inflammation is reportedly often associated with fat tissue deposits [19]. In particular, besides lymph node enlargement, an extensive mesenteric fat accumulation has been reported in patients with Fitz-Hugh-Curtis syndrome, a rare complication of C. trachomatis infection [20,21].…”

Section: Discussionmentioning

confidence: 99%