Tubo-ovarian abscesses: spectrum of sonographic findings with surgical and pathological correlations.
OBJECTIVE
Pelvic inflammatory disease (PID) is a serious condition that can lead to abscess formation. The purpose of this study was to identify the different sonographic markers on gray scale and color Doppler sonography in tubo-ovarian abscesses.


METHODS
The study group consisted of 25 women in whom the presence of tubo-ovarian abscess was confirmed by surgery and histopathology and their ultrasound records were analyzed retrospectively.


RESULTS
Presence of a mass was found in all cases. The maximum diameter of the mass was 5 cm in two cases and between 5 cm and 10 cm in 23 cases. The mass was demonstrated at the anatomic position of the ovary in 21 cases (84%) and at the cul-de-sac in four cases (16%). The mass was a simple cyst in two cases (8%), in four cases it was cystic with diaphragms (16%), in four cases it was a thickened tube-shaped structure with multiple internal echoes (16%) and in 15 cases it was a mixture of cystic and solid elements (60%). Pyosalpinges with fluid-fluid levels were found in two cases. Fluid in the cul-de-sac was observed at a rate of 48%. Color Doppler sonography demonstrated abundant blood flow in the borders and the septa of the tuboovarian abscesses in 90% of the studied cases.


CONCLUSIONS
The ultrasonographic findings of tubo-ovarian abscesses are not specific. The presence of a mass at the anatomic position of the ovary or at the cul-de-sac in combination with an increased number of white blood cells, elevated erythrocyte sedimentation rate and clinical findings are helpful for a correct diagnosis. Also, the color Doppler flow can further characterize the nature of the pelvic mass by detecting a significant rich blood flow in most cases of tuboovarian abscesses.
Varras
M
M
Department of Gynaecology, G. Gennimatas General Hospital, Second District National Health System, Athens, Greece.
Polyzos
D
D
Perouli
E
E
Noti
P
P
Pantazis
I
I
Akrivis
Ch
Ch
D015746:Abdominal Pain; D000038:Abscess / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005184:Fallopian Tube Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005334:Fever; D006801:Humans; D007962:Leukocytes / Q000473:pathology; D008875:Middle Aged; D010049:Ovarian Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000292:Pelvic Inflammatory Disease / Q000150:complications*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color