Pathology of the Adnexa ch 45

Question 1

PID is an inclusive term for all pelvic infections:

Answer 1

• Endometritis
• Salpingitis
• Hydrosalpinx
• Pyosalpinx
• Periovarian Inflammation
• Tubo-Ovarian Complex
• Tubo-Ovarian Abscess

Question 2

PID and endometriosis are

Answer 2

diffuse disease processes of the female pelvic cavity.

Question 3

Most commonly, PID is caused by

Answer 3

sexually transmitted diseases including gonorrhea and chlamydia.

Question 4

Uncommonly, PID can also be caused by

Answer 4

ruptured appendix and peritonitis.

Question 5

Sonography is of limited value during

Answer 5

acute PID, or early onset, when inflammatory changes have not yet begun to manifest.

Question 6

In chronic PID, ultrasound can identify

Answer 6

dilated fallopian tubes (hydrosalpinx or pyosalpinx), an abscess, or complex intraperitoneal fluid.

Question 7

PID occurs in

Answer 7

11% of young women during reproductive age, with peak incidence at 20 to
24 years

Question 8

Risk factors of PID

Answer 8

• Early sexual contact
• Multiple sexual partners
• History of STI
• Previous history of PID
• Intrauterine Contraceptive Device (IUD)

Question 9

Clinically, patients may present with

Answer 9

intense pelvic pain and tenderness described as dull and aching, with constant vaginal discharge.

Question 10

Vaginitis is the

Answer 10

most common initial clinical presentation of the early stages of PID.

Question 11

Other symptoms include

Answer 11

fever, pain in right upper abdomen, painful intercourse, irregular menstrual bleeding.

Question 12

Endometritis sonograph

Answer 12

thickening or fluid in endometrium

Question 13

Periovarian inflammation sonograph

Answer 13

enlarged ovaries with multiple cysts, indistinct margin

Question 14

Salpingitis sonograph

Answer 14

nodular thickening, irregularity of tube with
diverticula

Question 15

Pyosalpinx or hydrosalpinx sonograph

Answer 15

fluid-filled irregular fallopian tube with or without echoes

Question 16

Tubo-ovarian abscess sonograph

Answer 16

complex mass with septations, irregular margins, internal echoes; usually in cul-de-sac

Question 17

salpingitis

Answer 17

Inflammation of fallopian tube

Question 18

salpingitis clinical

Answer 18

ranges from asymptomatic to pelvic fullness or discomfort

Question 19

salpingitis sono

Answer 19

dilated tube, could be tortuous

Question 20

Hydrosalpinx

Answer 20

Obstructed tube filled with serous secretions

Question 21

Hydrosalpinx Occurs secondary to PID, endometriosis, or postoperative adhesions

Question 22

Hydrosalpinx clinical

Answer 22

ranges from asymptomatic to pelvic fullness or discomfort

Question 23

Hydrosalpinx sono

Answer 23

walls become thin due to dilatation, appearance of multi-cystic or fusiform mass, follow dilated tubes from uterine fundus, ampullary portion more dilated than interstitial part of tubes

Question 24

Pyosalpinx

Answer 24

Retained pus in oviduct with inflammation

Question 25

Pyosalpinx clinical

Answer 25

asymptomatic to pelvic fullness or discomfort, low-grade fever

Question 26

Pyosalpinx sono

Answer 26

may appear as complex mass, pus within dilated tube very thick and echogenic

Question 27

Tubo-Ovarian Abscess

Answer 27

Adhesive, edematous, inflamed serosa may further adhere to ovary and/or other peritoneal surfaces, which distorts anatomy.

Question 28

Tubo-Ovarian Abscess as infection worsens,

Answer 28

periovarian adhesions may form.

Question 29

Tubo-Ovarian Abscess Ovary cannot be separated from

Answer 29

inflamed dilated tube and called tubo-ovarian complex.

Question 30

Tubo-Ovarian Abscess usually responds

Answer 30

well to antibiotic treatment without need for surgical drainage

Question 31

Tubo-Ovarian Abscess serial ultrasound images during treatment allow

Answer 31

observation of resolution

Question 32

Peritonitis

Answer 32

inflammation of the peritoneum (the serous membrane lining the abdominal cavity and covering the viscera)

Question 33

Peritonitis if infectious process spreads to involve

Answer 33

bladder, ureter, bowel, and adnexal area, it becomes pelvic peritonitis.

Question 34

Peritonitis caused by

Answer 34

infectious organisms that gain access by way of rupture or perforation of viscera or associated structures; via the female genital tract; by piercing abdominal wall; via bloodstream or lymphatic vessels; via surgical incisions; or by failure to practice antiseptic techniques during surgery

Question 35

Sonographic Findings of Peritonitis

Answer 35

• Gas-forming bubbles
• Loculated areas of fluid within pelvis, paracolic gutters, mesenteric reflections
• Evaluation of space between right kidney and liver and left kidney and spleen where free fluid can form

Question 36

TA or TVS guidance used for

Answer 36

aspiration of benign-appearing cysts

Question 37

TVS drainage helpful

Answer 37

in TOAs; other pelvic abscesses, such as appendicitis and diverticulitis;
drainage of postoperative fluid collections

Question 38

TVS also used in

Answer 38

obtaining biopsies for benign and malignant solid pelvic masses and to drain
recurrent malignant collections