CT and MRI features of pelvic inflammatory disease

What is pelvic inflammatory disease (PID), and what are its CT and MRI features?

PID is common and covers a spectrum of infectious diseases involving the reproductive tract of women, including endometritis, cervicitis, salpingitis, and oophoritis, along with some more advanced manifestations of disease. Patients typically present with vaginal discharge, pelvic pain, fever, and leukocytosis. It is the most common cause for emergency room visits in the U.S.

CT and MRI findings include subtle mesenteric, omental, or pelvic visceral inflammatory fat stranding (the earliest imaging feature of PID); thickening of the uterosacral ligaments; pelvic peritoneal or endometrial fluid or gas; hyperenhancement or enlargement of the endometrium, cervix, fallopian tubes, or ovaries; thickening of the fallopian tubes (the most specific imaging feature of PID), sometimes with dilation by fluid or pus (i.e., hydrosalpinx or pyosalpinx), and often with ovarian involvement (tubo-ovarian abscess [TOA]); abdominopelvic abscess formation; and perihepatic inflammatory fat stranding or fluid, sometimes with peritoneal thickening and enhancement (Fitz-Hugh–Curtis syndrome). When an intrauterine device is present, infection by Actinomyces israelii is more likely and should be considered in the differential diagnosis.


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