Chapter 15: PID and Endometriosis

• Adenomyosis:


  Presence of endometrial glands and tissues found within the uterine wall
• Dysmenorrhea:


  Painful menstruation
• Dyspareunia:


  Painful intercourse
• Endometrioma:


  Blood-filled cyst located on the ovary that is the result of endometriosis
• Endometriosis: 


  Implants of endometrial tissue outside the uterus
• Endometritis:


  Bacterial infection of the endometrium with potential extension into the surrounding (parametrial) tissues
• Fitz-Hugh-Curtis syndrome:


  Rare complication of pelvic inflammatory disease, resulting in the development of liver adhesions from inflammatory exudates
• Myometritis:


  Myometrial inflammation
• Oophoritis:


  Infection/inflammation of ovary
• Parametritis:


  Infection of the connective tissue surrounding the uterus
• Pelvic Inflammatory Disease:


  Infection of the female reproductive tract
• Peritonitis:


  Infection of the peritoneum
• Pyosalpinx:


  Pus within the fallopian tube
• Salpingitis:


  Infection of the fallopian tube
• Tubo-ovarian abscess:

  Infection found in the late stages of PID, resulting in inability to differentiate tubal and ovarian structures
• Tubo-ovarian complex:


  Ability to identify the ovary and fallopian tube in the presence of adhesions or infection
• PID begins at the lower genital tract.
• What are some laboratory findings associated with pelvic inflammatory disease ?


  Elevated WBC in blood or vaginal secretions, high erythrocyte sedimentation rate (ESR), elevated C-reactive protein, positive gonorrhea or chlamydia, and positive bacterial vaginosis
• What are some signs/symptoms of PID ?

  Lower abdominal/pelvic pain, fever, increased WBC, and mucopurulent cervical discharge
• What are the 4 stages of PID ?

  Stage 1 - Endometritis, Stage 2 - Salpingitis, Stage 3 - TOC or TOA, and Chronic Disease
• What are some signs/symptoms of Fitz-Hugh-Curtis syndrome ?

  Right sided pleuritic pain, RUQ pain, and tenderness with palpation
• What are some sonographic findings of the uterus that could suggest acute PID ?

  Mildly enlarged uterus, blurring of myometrial or endometrial junction, and indistinct pelvic borders
• What are some sonographic findings of the endometrium that could suggest acute PID ?

  Thickened, heterogeneous, and may contain fluid
• What are some fallopian tube changes that could imply acute PID ?

  Thickened, edematous wall over 5 mm, pyosalpinx, and a dilated tubal structure due to septa
• What is the difference between tubo-ovarian abscesses and tub-ovarian complexes ?

  TOA: unable to separate ovary/tube during sonographic exam; TOC: able to separate organs
• What are some sonographic findings for chronic PID ?

  hydrosalpinx, sausage shaped, anechoic adnexal structure with incomplete septa, wall thickness over 5 mm, and the possibility of hydrosalpinges torsion
• What are the 4 stages of endometriosis ?

  Stage 1 - minimal, Stage 2 - mild, Stage 3 - moderate, Stage 4 - severe
• What are the 2 types of lesions associated with endometriosis ?

  Peritoneal and ovarian lesions
• Endometriomas are an ovarian lesion.
• What are some sonographic findings of endometriomas ?

  Mass in the adnexa with peripheral Doppler flow, thick walled, homogeneous, usually unilocular with occasional septations
• What are some signs/symptoms of adenomyosis ?

  Abnormal bleeding, dysmenorrhea, and an enlarged, tender uterus
• What are some sonographic signs of adenomyosis ?

  Hypoechoic or hyper echoic uterus, heterogeneous myometrium, diffusely enlarged, and myometrial cysts