Adenxal Infections

PID

Infectious disease of female reproductive organs

4 stages

Ascending infection

Usually originates from vAgina, starts in UT and extends into tubes/adnexa

First symptom of infection

Vagninitis

PID can lead to

Fitz-Hugh-Syndrome: Inflammation of peritoneum

Increased risk of ectopic pregnancy due to tubal damage, formation of cervical polyps, infertility

Stage 1 PID: Acute endometritis

Endometrial fluid/debris/air

Fluid in posterior cul-de-sac

Increased vascularity on Doppler

Stage 2 PID: Acute salpingitis

Fluid or pus within tubes

Shaggy appearance of tube walls

Thick walled tubes with acute infection (>5mm)

COGWHEEL SIGN - demonstrated in cross-sectional view, longitudinal folds of tube thicken

Stage 3 PID: Acute tubo-ovarian abscess

Multilocular retro-uterine/adnexal masses with debris

May see comet tail artifact due to air produced with bacterial infection

Septations

Irregular thick walls

Commonly bilateral

May see echogenic debris in pelvis

Stage 4 PID: Chronic infection

Hydrosalpinx, pyosalpinx, hematosalpinx

Thin walled fallopian tube (<5mm)

BEADS ON STRING SIGN - remnants of endosalpingeal folds demonstrate multiple 2-3mm nodules

Peritoneal inclusion cyst

PID is associated with

CHLAMYDIA, gonorrhea, TORCH infections, poor hygiene, tuberculosis, non-sterile surgical instruments, childbirth, intrauterine contraception, ruptured appendix

PID symptoms

VAGINITIS, bleeding, discharge, pain, N/V, dysuria, fever, rapid pulse, increased WBC’s, palpable mass

• Possible elevated CA-125, C-reactive protein

USA acute PID

Enlarged, swollen uterus, prominent irregular endo

Fluid in cul-de-sac

Edematous adnexa

Hydrosalpinx/pyosalpinx, COGWHEEL

Hypervascularity of tube walls

Abcess

USA chronic PID

Normal UT

Fluid in cul-de-sac

Ascites

Hydrosalpinx/pyosalpinx

Beads on string

Acute PID (cogwheel)

Hydrosalpinx (PID)

Pyosalpinx (PID)

Tubo-ovarian abscess

Bilateral

Associated with PID and IUDs

Tubo-ovarian abscess is caused by

Ascending infection

Tubo-ovarian abscess symptoms

Pain, fever, nausea, leukocytosis

Tubo-ovarian abscess USA

Abnormally thickened endometrium

Hydrosalpinx/pyosalpinx

Complex adnexal mass

• Adnexal borders

• Septations and debris

• Gassy (DIRTY) SHADOWING may be seen

Tubo-ovarian abscess

Most common cause of acute abdomen pain

Acute appendicitis

Acute LLQ pain is commonly associated with

Diverticulitis

Acute RLQ pain is commonly associated with

Acute appendicitis

Appendix is located …

Posterior to terminal ileum and anterior to iliac vessels

In MCBURNEY’s point

Acute appendicitis symptoms/findings

RLD pain, increased WBC, fever, rebound tenderness with transducer compression

Appendicitis can lead to …

Bacterial infection → leads to gangrene and possible perforation

Fecalith

Hard stony mass of feces in intestinal tract that can obstruct the appendix

also known as coprolith and stercolith

USA acute appendicitis

Use graded compression technique

Blind ended structure that will not respond to compression

Aperistalic tube with gut signature that arises from cecum base

TARGET SIGN trans

INCREASED vascularity

Fluid

Gangrenous = lack of blood flow

Diameter of acute appendicitis >__, wall >__

6; 2

Appendicitis

Diverticulitis

LLQ pain, fever, increased WBC

Segmental, concentric, thickening of wall

MOST COMMON in sigmoid colon

Diverticulitis USA

Inflamed diverticulum (out puching >4mm)

Echogenic areas in wall

Pseudokidney sign - Abnormal bowel thickening

Cogwheel sign indicated what stage of PID

Acute salpingitis