The diagnosis of pelvic inflammatory disease (PID) is usually made clinically, without the aid of ancillary studies. Ultrasound findings are unlikely to be noted early in the course of PID. In cases of severe PID, the ultrasound examination may demonstrate free fluid in the cul-de-sac or pyosalpinx. Pyosalpinx is an enlarged pus filled fallopian tube, which appears sonographically as a distinct circular structure with low-level echoes in the lumen when imaged in cross section. Pyosalpinx may appear to be a multicystic mass if multiple loops of distended tube are lying adjacent to one another. Sonographic evidence of pyosalpinx has been shown to be specific for the diagnosis of PID.19 Tuboovarian abscess (TOA) is a complication of PID that can be accurately diagnosed using pelvic ultrasound. An abscess will appear sonographically as a complex mass with both cystic and solid components (Fig 109-24). Percutaneous or transvaginal drainage of a TOA may be facilitated by ultrasound guidance.
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