Toggle navigation. Register Login. September - Volume 18 - Issue 3. Previous Abstract Next Abstract. Article as EPUB. The luminal fluid may be purely anechoic or complex with floating echoes. The inflamed ovary can acquire a reactive polycystic appearance, and eventually become adherent to the tube, often situated posteriorly and inferiorly in the region of the cul-de-sac. This is termed a tubo-ovarian complex. Persistent untreated disease leads to disruption of the normal adnexal and ovarian architecture with leakage of pus from the tube and the formation of a tubo-ovarian abscess TOA , which appears as a complex, mixed solid and cystic mass in the pelvis Fig.
Treatment for advanced PID involves the use of broad-spectrum antibiotics. Abscesses are drained using image guidance, either ultrasonography or CT, with catheters placed via a transgluteal, transvaginal, or transrectal route.
Gray-scale A and color B sonograms show a complex solid and cystic mass in the right adnexa with internal vascularity in this patient with tubo-ovarian abscess. This patient ultimately underwent percutaneous transgluteal drainage under computed tomography guidance.
Acute-onset pelvic pain in premenopausal nonpregnant women is a very common symptom in ED patients. Adnexal causes of pain are numerous, and accurate diagnosis is important in order to distinguish between emergency surgical conditions and those that can be managed expectantly or with medical therapy. The prompt initiation of appropriate therapy is key for the successful management of patients with certain conditions, such as ovarian torsion or PID and TOA.
As a radiation-free and relatively inexpensive imaging modality, ultrasonography plays a most important role in diagnosis and management of these patients. We would like to express our gratitude to Dr.
No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U. Journal List Ultrasonography v. Published online May 9. Carolyn S. Dupuis and Young H. Author information Article notes Copyright and License information Disclaimer. Correspondence to: Young H. This article has been cited by other articles in PMC. Abstract Acute-onset pelvic pain is an extremely common symptom in premenopausal women presenting to the emergency department.
Introduction Acute-onset pelvic pain is an extremely common symptom in premenopausal women presenting to the emergency department ED. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Ovarian hyperstimulation syndrome. J Hum Reprod Sci. Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. UCSF Health. More in PCOS.
Also known as the cul-de-sac, the pouch of Douglas exists between the uterus and the rectum and is the most dependent area of the pelvis, where fluids pool. Physiologic and pathologic cul-de-sac fluid takes many forms. Menstrual blood that has refluxed through the fallopian tubes and fluids related to ovulation or ruptured cysts settle in it. Likewise, blood from a ruptured ectopic pregnancy, inflammatory debris from a pelvic or appendiceal infection and ascites due to malignancy, liver or cardiac failure may collect here.
The amount may be copious or simply a small bit that is noted on routine ultrasound evaluation. Why the Test is Performed This procedure is rarely done today because a transvaginal ultrasound can show fluid behind the uterus.
It may be done when: You have pain in the lower abdomen and pelvis, and other tests suggest there is fluid in the area. You may have a ruptured ectopic pregnancy or ovarian cyst. Normal Results No fluid in the cul-de-sac, or a very small amount of clear fluid, is normal. What Abnormal Results Mean Fluid may still be present, even if not seen with this test. Comprehensive Gynecology.