Diagnostic Ultrasound - Abdomen and Pelvis

Endometritis
Diagnoses: Female Pelvis
TERMINOLOGY
• Polymicrobial infection resulting from ascending spread of
organisms from cervix into uterus
IMAGING
• Findings often normal or nonspecific
○ Endometrial gas and fluid in a patient with postpartum
fever and pelvic pain
○ Thickened, heterogeneous endometrium
• Imaging usually ordered to look for complications:
Pyometrium, abscess, retained products of conception
(RPOC)
TOP DIFFERENTIAL DIAGNOSES
• RPOC
• Intrauterine blood/clot
• Asymptomatic postpartum endometrial gas
• Endometrial calcifications
• Other causes of postpartum fever
KEY FACTS
PATHOLOGY
• Generally caused by ascending spread of organisms
through cervix or incision site into uterus
CLINICAL ISSUES
• Fever and pain in postpartum period (most common)
○ More common following cesarean section than vaginal
delivery
• Occasionally associated with pelvic inflammatory disease
(PID) in nonobstetric patient
• Rarely leads to development of pelvic septic
thrombophlebitis
DIAGNOSTIC CHECKLIST
• Endometritis is predominantly a clinical diagnosis
• In appropriate clinical setting (postpartum fever and pain)
the presence of endometrial fluid and bubbles is highly
suggestive of endometritis
(Left) Graphic shows findings
in endometritis including
hyperemia of the
endometrium ſt, with
associated fluid and gas
bubbles st in the endometrial
cavity. (Right) Longitudinal
transvaginal ultrasound shows
nonspecific endometrial
thickening ſt and fluid in
this patient with clinical
endometritis, evidenced by
vaginal discharge and pelvic
pain.
(Left) Longitudinal
transvaginal ultrasound with
color Doppler shows fluid and
debris within the
endometrial cavity in a patient
with clinical endometritis
following D&C. (Right)
Transabdominal longitudinal
ultrasound shows extensive
gas within the uterus, visible
as echogenic foci ſt with
heterogeneous posterior
shadowing "dirty
shadowing." The patient
presented with pelvic pain and
vaginal discharge following
recent fibroid embolization.
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