Imaging of Pelvic Inflammatory Disease, Part II

In the second part of this video lecture, we discuss the MRI appearance of pelvic inflammatory disease (PID), including tips on how to differentiate pyosalpinx from both hydrosalpinx and hematosalpinx.  The computed tomography (CT) and ultrasound appearance of associated complications of PID are also reviewed.

Topics include:

• Using diffusion-weighted imaging to differentiate pyosalpinx/tubo-ovarian abscess (TOA) from hydrosalpinx.
• Association between hematosalpinx and endometriosis.
• Fitz-Hugh-Curtis perihepatitis syndrome and its CT appearance on both late hepatic arterial phase and portal venous phase imaging.
• Imaging appearance of endometritis, including fluid-filled dilated endometrial cavity, subendometrial enhancement, gas, “dirty” shadowing and (most importantly) presence of clinical suspicion.
• Ovarian vein thrombosis, with emphasis on identifying enhancing, thickened venous walls and perivenous inflammation as findings of thrombophlebitis.
• TOA secondary to diverticulitis.
• How oxidized regenerated cellulose can mimic pelvic abscess and can normally contain gas for at least a month after surgery, highlighting the importance of reviewing the details of the operative history.

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References:

• Revzin MV,  Mathur M, Dave HB, et al. Pelvic inflammatory disease: Multimodality imaging approach with clinical-pathologic correlation. Radiographics. 2016;36(5):1579-1596.
• Kim D, Kim TU, Lee JW, et al. The perihepatic space: Comprehensive anatomy and CT features of pathologic conditions. Radiographics. 2007;27(1):129 –143.
• Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: Spectrum of CT findings. Radiographics. 2002;22(4):785–801.
• Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 2002;22(6):1327–1334.
• Kaakaji Y, Nghiem HV, Nodell C, Winter. TC. Sonography of obstetric and gynecologic emergencies. Part II, Gynecologic emergencies. AJR Am J Roentgenol. 2000 Mar;174(3):651-656.
• Kim MY, Rha SE, Oh SN, et al. MR imaging findings of hydrosalpinx: a comprehensive review. Radiographics. 2009;29(2):495-507.
• Ha HK, Lim GY, Cha ES, et al. MR imaging of tubo-ovarian abscess. Acta Radiol. 1995;36(5):510-4.
• Wilbur AC, Aizenstein RI, Napp TE. CT findings in tuboovarian abscess. AJR Am J Roentgenol. 1992;158(3):575-9.
• Young ST, Paulson EK, McCann RL, Baker ME. Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess. AJR Am J Roentgenol. 1993;160(2):275-277. 
• Sandrasegaran K, Lall C, Rajesh A, Maglinte DT. Distinguishing gelatin bioabsorbable sponge and postoperative abdominal abscess on CT. AJR Am J Roentgenol. 2005;184(2):475-480.

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