TRANSVAGINAL SONOGRAPHIC MARKERS OF TUBAL INFLAMMATORY DISEASE

Objectives Since the introduction of transvaginal sonography (TVS), cl ear pictures of the female reproductive tract have been obtained. Thes e images enable the accurate description of Fallopian tube pathology. However; the current literature on the ultrasound diagnosis of pelvic inflammatory disease (PID) is confusing and contradictory The goal of our study was to identify sonographic markers of inflammatory disease of the pelvis and to place these in a clinical context. Patients and m ethods Seventy-seven patients were scanned by TVS. They were divided i nto two groups, according to their clinical picture, the first group w ith acute PID and the second with a history of chronic PID or no histo ry at all. The sonographic markers studied were shape, wall structure and wall thickness of the Fallopian tube. Ovarian involvements and the presence of pelvic fluid were also evaluated. Results The best marker of tubal inflammatory disease, either acute or chronic, was the prese nce of an incomplete septum of the tubal wall, which was present in 92 % of the total cases. A thick wall and the 'cogwheel' sign were sensit ive markers of acute disease, whereas a thin wall and 'beads-on-a-stri ng' sign were indicators of chronic disease. Palpable findings and sur gical history were not discriminatory, but were present in three-quart ers and one-third of the study population, respectively, Three false-p ositive cases are presented: air ovarian cystadenoma, an appendiceal m ucocele and one case with periovarian fluid accumulation. Conclusions The tubo-ovarian complex and the tubo-ovarian abscess should be consid ered separate entities that differ in their clinical implications. TVS allows one to distinguish between them. Distinguishing characteristic s of acute and chronic salpingitis are presented.