Pelvic inflammatory disease with hydrosalpinx

Case contributed by M.D Nikos Barmpagiannis

Presentation

Vaginal excretions, lower abdomen pain for 2-3 days, elevated CRP and WBC count.

Patient Data

Age: 25 years
Gender: Female

Pelvic US (selected images)

Ultrasound

Trans-abdominal scan of the lower abdomen reveals a dilated fluid filled left salpinx with subtle waist sign (diametrically opposed indentations) on longitudinal scan. Transverse scan shows thickened ensosalpingeal walls (cogwheel sign). No effusion in the pouch of Douglas, as is often the case.

Case Discussion

Pelvic inflammatory disease is relatively common in this age group, especially in females with multiple sex partners. It is usually caused by an ascending infection. Involvement of the ovaries usually results in a tubo-ovarian complex, in which case the architecture of the ovary is preserved, or tubo-ovarian abscess, where there is no identifiable ovary or fallopian tube. Long-term complications include adhesion formation and infertility.

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