pelvic inflammatory disease, and infertility pelvic inflammatory disease, and infertility

Pelvic inflammatory disease

An infection of the upper genital tract

Risk factors of PID

History of PID, the utilization of an intrauterine contraceptive device, post abortion, post, childbirth, douching , multiple partners, early sexual contact

Clinical presentation of PID

Fever , Chills, pelvic pain, cervical mission, tenderness, pearl, vaginal discharge, foul odor, vaginal itchiness, vaginal bleeding, dyspareunia, leukocytosis

Sonographic appearance of acute PID

Thickened irregular endometrium the uterus may have ill defined borders and filling tubes may contain fluid echogenic material within tube (pyosalpinx) or (hydrosalpinx). Possible tubo-ovarian abscess

What can chronic PID lead to?

Continue pelvic or abdominal Pain, infertility, possible, palpable, adnexal mass, and irregular Menses

Sonographic appearance of chronic PID

Reveals evidence of markedly, distended fallopian tubes, the development of adhesion between the pelvic organs, findings, consistent with tubo, ovarian complex and or tubo ovarian abscess

Vaginitis

Most common initial clinical presentation (early stages). Can progress into cervix

Cervicitis

Progression of vaginitis into cervix

Endometritis

Inflammation of endometrium

Clinical findings of endometriitis

Recent abortion, post partum, D&C, PID, surgery, OR IUD. Pelvic tenderness, fever, leukocytosis

Sonographic findings of endometritis

Thickened echogenic or irregular endometriuium. Endometrial fluid. Ring down artifact from gas OR air. Color Doppler can show hyperemia

Fitz-hugh-curtis syndrome

Perihepatic infection (development of adhesions located between liver and diaphragm) that results in liver capsule inflammation from pelvic infection

Clinical findings of fitz-hugh-curtis syndrome

RUQ pain, fluid in Morrison pouch (hepatorenal space)

Clinical findings of salpingitis

Consistent with PID, tenderness in pelvis, Fever, leukocytosis

Sonographic appearance of salpingitis

Distended fallopian tube filled with echogenic material or anechoic fluid, hyperemic flow within or around affected fallopian tube, modular thickened wall of fallopian tube

Pyosalpinx

Result of tube distending with pus

Sonograhic appearance of pyosalpinx

Dilated uterine tube filled pus, containing separation and internal echoes, thickened edematous uterine wall 5mm.

Tubo - ovarian complex

Adhesions develop within pelvis that lead to fusion of ovaries and dilated tubes. (Due to progression of PID beyond fallopian tubes , ovaries B peritoneum become involved )

Tubo ovarian abscess

Progression tubo-ovarian abscess

Sonographic findings of Tubo-ovarian complex

Thickened, irregular endometrium, cul-de-sac fluid ,multicystic and sold complex adnexal mass ovaries and tubes are distinct but not able to separate

Causes of infertility

Uterine malformations, endometriosis , PCOS, asherman syndrome, leiomyomas

Endometriosis

Functional ectopic endometrial tissue located outside the uterus, can be a result of endo tissue being passed through fallopian tubes during menstruation OR surgery scarring. Can be located anywhere in the body, commonly in the ovaries

Endometriomas

Aka chocolate cyst, hemorrhaging of ectopic endometrial tissue resulting in focal areas of bloody tumors

Clinical findings of endometriosis

Asymptomatic, pelvic pain, infertility, dysmenorrhea, menorrhagia, painful bowel movements

Sonographic appearance of endometriosis

Predominantly cystic mass with low level internal echoes resembling hemorrhagic cyst. Anechoic or complex mostly cystic mass with posterior enhancement and may contain a fluid-fluid level

PCOS

Aka Stein-leventhal syndrome. Endocrinologic ovarian disorder linked with infertility.

Clinical findings of PCOS

Stein-leventhal syndrome (amenorrhea, hirsutism, and obesity). Infertility, oligomenorrhea, hyperandrogenism

Sonographic findings of PCOS

String of pearls sign, small cyst along periphery of the ovary. Small cyst scattered throughout ovary. Bilateral enlargement of the ovaries. Increased stroma and increased stomach echogenicity. 12 or more (25) follicles that measure 2-9mm.

Luteal phase deficiency

Underdevelopment of endometrium during luteal phase as a result of reduced progesterone production by ovary. Endo is thickened and echogenic (secretory phase)

Asherman Syndrome

Presence of intrauterine adhesions or synechiae within the uterine camity as a result of scar formation after uterine surgery.

Clinical findings of Ashermann syndrome

History of D&C trauma and uterine surgery. Recurrent pregnancy loss, amenorrhea or hypomenorrhea

Sonographic appearance of asherman syndrome

Bright areas within the endometrium, sonohysterography findings include bright bands of tissue traversing the uterine cavity

Uterine leiomyoma

Benign, smooth muscular tumor of the uterus also known as a fibroid or myoma.

Clinical findings of uterine leiomyoma

Pelvic pressure, menorrhagia, palpable abdominal mass, enlarged, bulky uterus (if multiple). Urinary frequency, dysuria, constipation, infertility