Pelvic Inflammatory Disease

Preliminary Diagnosis: Pelvic Inflammatory Disease

I. What imaging technique is first-line for this diagnosis?

Ultrasound of the pelvis. (Transvaginal approach offers more exquisite imaging compared to a transabdominal approach.)

II. Describe the advantages and disadvantages of this technique for diagnosing pelvic inflammatory disease.

Advantages

• Highly portable imaging modality.

• Does not expose patients to ionizing radiation.

• Offers exquisite imaging of the uterus and bilateral ovaries.

• Able to characterize the vascularity of the ovaries and uterus and evaluate for ovarian torsion.

Disadvantages

• Less adept in detailing and characterizing the surrounding soft tissues and osseous structures.

• Less adept in detailing any subtle secondary complications from pelvic inflammatory disease.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

• CT of the abdomen and the pelvis with IV contrast.

• MR of the abdomen and pelvis with IV contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pelvic inflammatory disease.

CT of the abdomen and the pelvis with IV contrast

Advantages

• Offers exquisite detail of the surrounding soft tissues, vascular structures, and osseous structures.

• May characterize the primary abnormality and evaluate for any secondary complications better than other imaging modalities.

Disadvantages

• Exposes patients to ionizing radiation.

• Less adept in evaluating for ovarian torsion.

MR of the abdomen and pelvis with IV contrast

Advantages

• Does not expose patients to ionizing radiation.

• Offers exquisite detail of the surrounding soft tissues.

Disadvantages

• Expensive.

• Time consuming.

• May be subject to motion and susceptibility weighted artifact, degrading image quality.

• Offers less visualization of the surrounding osseous structures.

VI. What are the contraindications for the alternative imaging techniques?

CT of the abdomen and the pelvis with IV contrast

May be contraindicated in pregnant patients.

MR of the abdomen and pelvis with IV contrast

May be contraindicated in patients with non-MR compatible hardware.