Tubo-ovarian abscess

Tubo-ovarian abscesses are one of the late complications of pelvic inflammatory disease.

Risk factors include 15:

Patients typically present with a combination of fever, elevated inflammatory markers, lower abdominal-pelvic pain, and vaginal discharge. Fever and leukocytosis may sometimes be absent.

Abscesses are often polymicrobial with a preponderance of anaerobic organisms 9.

The clinical context is extremely important in radiological interpretation. Patients will experience tenderness with endovaginal scanning. Some differentiate between:

  • tubo-ovarian "abscess": ovary and tube cannot be separately distinguished within the inflammatory mass
  • tubo-ovarian "complex": if the tube and ovary are separately discernible structures within the inflammatory mass

Features are non-specific and may include:

  • soft tissue density mass
  • loss of normal pelvic fat planes
  • an adynamic ileus may be present

Transabdominal and endovaginal ultrasound are the preferred initial imaging investigations. Findings may include:

  • multilocular complex retro-uterine/adnexal mass
    • debris, septations, and irregular thick walls
  • commonly bilateral
  • echogenic debris within the pelvis

Can be a helpful adjunct to ultrasound especially in determining the extent of disease 3:

  • fluid attenuation pelvic masses which may contain fluid-fluid levels or gas
  • usually shows a thick enhancing wall
  • a tubular configuration is more conclusive of a pyosalpinx

Can be useful especially when sonography is inconclusive or if the gas content is difficult to be differentiated from bowel gas 5.

Typically seen as thick-walled fluid-filled pelvic mass(es) 12

  • T1: abscess contents typically hypointense
  • T2: abscess contents typically heterogeneous signal or hyper-intense

Initial treatment can be with antibiotic therapy. Radiological guided drainage or surgery may be required in patients resistant to antibiotic treatment. Drainage may be performed from an endovaginal, transgluteal, or trans-abdominal approach, dependent on patient and operator preference 4.

Recognised complications include:

Clinical features of infection is a key to aid diagnosis as a number of other pathologies can give similar appearances 1:

Ultrasound - gynaecology
Share article

Article information

rID: 9818
System: Gynaecology
Synonyms or Alternate Spellings:
  • Tuboovarian abscess
  • Tuboovarian abscess (TOA)
  • Tubo-ovarian abscesses
  • Tuboovarian abscesses
  • Tubo-ovarian complex
  • Tuboovarian complex

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Axial T2
    Case 2: on MRI with incidental uterine didelphys
    Drag here to reorder.
  • Drag
    Case 3: with IUCD
    Drag here to reorder.
  • Drag
    Case 4: on MRI - complication of IUCD (removed)
    Drag here to reorder.
  • Drag
    Case 5: on ultrasound
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Drag
    Case 8: bilateral
    Drag here to reorder.
  • Drag
    Case 9
    Drag here to reorder.
  • Drag
    Case 10
    Drag here to reorder.
  • Drag
    Case 11
    Drag here to reorder.
  • Drag
    Case 12
    Drag here to reorder.
  • Drag
    Case 13
    Drag here to reorder.
  • Updating… Please wait.

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.