E2454. Ultrasound Evaluation of Pelvic Inflammatory Disease
  1. Margarita Revzin; Yale School of Medicine
  2. Duglas Katz; Winthrop University Hospital
  3. Christine Menias; Mayo Clinic Arizona
Pelvic inflammatory disease is a common medical problem, with almost 1 million cases diagnosed annually. PID encompasses all upper genital tract infections, including cervicitis, endometritis, salpingitis, oophoritis, hydrosalpinx, tubo-ovarian abscess, and peritonitis. The cause of PID is typically an ascending infection with involvement of the upper genital tract. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography or magnetic resonance imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Understanding sonographic imaging findings associated with an early, late, and advanced PID are paramount for prompt diagnosis, recommendation for additional imaging, and effective management.

Educational Goals / Teaching Points
Discuss pathophysiology, common and rare pathogens and clinical spectrum of the pelvic inflammatory disease. Review early, late and advanced sonographic findings of PID with some relevant CT and MRI correlations. Review sonographic findings of common and uncommon complications of PID. Discuss potential mimics on ultrasound.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
ultrasound, pelvic inflammatory disease as a spectrum of upper genital tract infection Imaging findings of the early and late and advanced PID

Knowledge of pathophysiology, common and rare pathogens and clinical spectrum of the pelvic inflammatory disease helps to accurately diagnose patients with pelvic inflammatory disease. Sonography is a first line imaging examination of PID and is usually diagnostic in early forms of PID. MRI is a complimentary imaging modality, the main role of which is in challenging cases or cases of advanced PID and complications. CT imaging helps with assessment of spread of the disease and potential complications. Understanding sonographic imaging appearance of early and late presentation of PID prevents misinterpretations. A radiologist should be aware of potential pitfalls in diagnosis on ultrasound, and, if necessary, employ other cross-sectional modalities.