These patients demonstrate the clinical and sonographic spectrum of pelvic inflammatory disease. Despite the severity of the disease exhibited in Patient A, the cystic adnexal masses completely resolved on intravenous antibiotics, and the patient was symptom-free approximately 6 weeks later. Patient B had a more chronic clinical presentation and was subsequently proven at surgery to have bilateral hydrosalpinx and tubo-ovarian abscesses. It was not possible to distinguish these complex cystic masses sonographically from other ovarian lesions such as cystadenoma or cystadenocarcinoma.
Salpingitis and acute pelvic inflammatory disease are a major health care problem in the United States. Approximately one million women a year are treated for acute salpingitis, and over half are under the age of 20. Patients with salpingitis have a significantly increased incidence of both infertility and ectopic pregnancy (a 6- to 10-fold increase over the general population). The clinical diagnosis of acute salpingitis is not always straight forward, and only 20% of patients demonstrate the classic findings of pelvic pain, purulent discharge, adnexal tenderness, fever, and leukocytosis.
Sonography may aid the clinical assessment of pelvic inflammatory disease by 1) evaluating the status of disease in patients who are difficult to examine clinically, 2) objectively documenting response to therapy, and 3) suggesting the diagnosis when it is not clinically suspected. The sonographic findings in acute pelvic inflammatory disease are often nonspecific. However, the presence of unexplained free fluid and cystic adnexal masses should always raise the possibility of this diagnosis. Prompt antibiotic therapy can often arrest even significant disease, and at present approximately 70% of tubo-ovarian abscesses will respond to antibiotic therapy alone.
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