Case contributed by Verónica Martín Pérez
Diagnosis almost certain


Patient with clinical symptoms of pain in left iliac fossa and nausea, with no other associated symptoms. History of acute uncomplicated diverticulitis. Gynecological history showed uterine fibroids and placement of an intrauterine device 4 weeks ago. Laboratory tests showed elevated acute phase reactants with no associated leukocytosis. An abdominal CT scan was requested.

Patient Data

Age: 45 years
Gender: Female

CT images in the portal phase show a myomatous uterus with an intrauterine device inside. A serpiginous tubular structure adjacent to the uterus is seen presenting thickening and mural enhancement corresponding to the left ovarian tube with fluid content in its interior. The overall findings suggest pyosalpinx. A 3 cm right adnexal cyst is also seen.

Case Discussion

Gynecology department performed an ultrasound scan which supported the findings, classifying the case as pelvic inflammatory disease grade III with pyosalpinx. Intravenous and oral antibiotic therapy was started and the patient progressed well. STI tests were negative. Microbiological culture of the intrauterine device was performed showing colonization by Enterococcus faecalis.

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