Tubo-ovarian Abscess

Axial CT image of a young woman with left pelvic pain shows an enhancing, thick walled fluid collection in the left adnexa (arrows) inseparable from the left ovary. The right ovary is marked with an arrowhead.

Facts: Pelvic Inflammatory Disease

• Young, sexually active, reproductive-aged women
• Chlamydia trachomatis, Neisseria gonorrhoeae are the most common causative organisms
• Risk factors include sexual activity at a younger age, several sexual partners, nonuse of barrier contraception
• Complications include tubo-ovarian abscess (TOA; up to 30% of hospitalized patients with PID), perihepatitis

Clinical Diagnosis of PID

Abdominal tenderness, cervical motion tenderness and bilateral adnexal tenderness with at least one minor diagnostic criteria:

• Documented cervical infection with C trachomatis or N gonorrhoeae
• Mucopurulent cervicitis
• Temperature > 38.3 C
• Elevated erythrocyte sedimentation rate or C-reactive protein
• Presence of an inflammatory mass on pelvic sonography

Imaging of TOA

• Mass inseparable from the tube and ovary
• Complex mass, fluid attenuation, thickened and irregular enhancing wall
• Anterior displacement of the broad ligament may allow differentiation from pelvic abscesses from other sources (i.e. appendix, colon)

References:

1. Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin N Am 2008;22:693-708.

2. Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics 2008;28:1645-1659.