Tubo-Ovarian Abscess with Hydrosalpinx
CLINICAL MEDICINE Image Diagnosis: Tubo-ovarian Abscess with Hydrosalpinx Kiersten L Carter, MD; Gus M Garmel, MD, FACEP, FAAEM Perm J 2016 Fall;20(4):15-211 E-pub: 06/24/2016 http://dx.doi.org/10.7812/TPP/15-211 Tubo-ovarian abscess (TOA) and hydro- The most useful diagnostic imaging metronidazole with doxycycline) can usu- salpinx are complications, though uncom- studies include transvaginal ultrasonog- ally be initiated within 24 hours to 48 hours mon, of pelvic inflammatory disease (PID). raphy and computed tomography. Com- of clinical improvement to complete the Both TOA and hydrosalpinx can lead to sig- pared with ultrasonography, computed 14-day treatment course.4 The majority of nificant morbidity and, rarely, mortality, and tomography has increased sensitivity to small abscesses (< 9 cm in diameter) resolve both necessitate treatment to reduce short- detect thick-walled, rim-enhancing adnexal with antibiotic therapy alone.1 and long-term complications. Risk factors of masses, pyosalpinx, and mesenteric strand- The aim of therapeutic management is TOA include younger age, multiple sexual ing, as well as changes suggestive of ruptured to be as noninvasive as possible. However, partners, nonuse of barrier contraception, TOA.1 On computed tomography scan with if this approach fails to yield clinical im- and a history of PID.1 The clinical manifes- contrast, a hydrosalpinx is visualized as a provement within 3 days, reassessment of tations of TOA are similar to PID—lower dilated, fluid-filled fallopian tube without the antibiotic regimen, with consideration abdominal pain, fever, chills, and vaginal rim enhancement (Figures 1 and 2). for laparoscopy, laparotomy, adnexectomy, discharge, with the addition of pelvic mass Although TOA is a complication of PID, hysterectomy, or image-guided abscess noted on examination or imaging.
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