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Last revised by Dr Henry Knipe on 01 Jul 2022

Endometritis refers to inflammation or infection involving the endometrium. Endometritis can be acute or chronic and may arise in an obstetric setting, such as following delivery or miscarriage, or in a non-obstetric setting due to pelvic inflammatory disease (PID) or endometrial instrumentation.

It complicates 2-3% of vaginal deliveries as well as up to 27% of Cesarean sections 5. Endometritis is the most common cause of fever in a postpartum patient 6.

The typical presentation is with fever and lower abdominal pain. While imaging features can be helpful, the diagnosis is clinical as imaging can be normal, particularly in uncomplicated cases.

Recognized associations include 3:

Endometritis is a clinical diagnosis and caution should be taken due to the overlap of expected postpartum imaging findings and the ones related to the inflammatory process.

While the sonographic appearance of the uterus and endometrium may be normal in early stages, findings may include:

  • thickened and heterogeneous endometrium
  • intracavitary/cul-de-sac fluid
  • increased vascularity on Doppler ultrasound
  • intrauterine air
  • loss of a well defined interface between the endometrium and myometrium
    • described in cases occurring in the puerperal setting 7
    • may be associated with the development of a thin, hypoechoic layer in a subserosal distribution 8
  • T2: the uterus may be enlarged with overall high signal intensity
  • T1 C+ (Gd): can show intense enhancement of the uterus

Differential considerations include:

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Cases and figures

  • Case 1: post CS
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