Diagnostic Ultrasound - Abdomen and Pelvis

Tubo-Ovarian Abscess
Diagnoses: Female Pelvis
TERMINOLOGY
• Pelvic inflammatory disease (PID), tubo-ovarian abscess
(TOA), tubo-ovarian complex (TOC)
IMAGING
• Transvaginal ultrasound is first-line modality
○ Early disease may be subtle
○ Distended serpiginous, ovoid or pear-shaped tube
○ Thickened tube walls, often > 5 mm
○ Thickened endosalpingeal folds: Cogwheel sign in cross
section
○ Incomplete septa: Distended tube folding on itself
○ Tubo-ovarian abscess
○ Enlarged edematous ovary
○ Complex pelvic fluid collection
• CT useful for diffuse nonspecific symptoms, large
abscesses, extensive infection
• MR helpful if other modalities are equivocal
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Endometrioma ± rupture
• Hemorrhagic cyst ± rupture
• Paraovarian cyst
• Appendicitis
PATHOLOGY
• Ascending infection damages endocervical canal and its
mucus barrier, ascends into upper genital tract, involves
tube and ovary
• Advanced disease results in abscess collections
CLINICAL ISSUES
• Associated with STD
○ Usually present with pain, fever, vaginal discharge
• Can result in tubal scarring
○ Infertility, ectopic pregnancy, chronic pelvic pain
(Left) Longitudinal ultrasound
of a left tubo-ovarian complex
is shown. There is complex
fluid in the abscess ſt, which
is distinct from the ovary .
(Right) Coronal transvaginal
ultrasound shows a tuboovarian
abscess ſt with a pus
level st.
(Left) Coronal transvaginal
ultrasound of the right ovary
st and thickened tender
fallopian tube ſt secondary to
acute salpingitis is shown.
(Right) Coronal transvaginal
color Doppler ultrasound of
the same patient shows
increased color flow in the
right salpingitis ſt. Fluid was
seen in the tube . The ovary
st was hyperemic.
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