Pelvic inflammatory disease in the adolescent: comparison of transabdominal and transvaginal sonographic evaluation

Transabdominal (TA) and transvaginal (TV) sonograms (n = 116) were obtained in 84 patients aged 12-21 years (mean, 16.2 years) with the clinical diagnosis of acute pelvic inflammatory disease (PID). The studies were compared for image quality and unique diagnostic information. TV sonography demonstrated superior resolution of 25 dilated fallopian tubes. Heterogeneous pelvic masses, described as tubo-ovarian abscesses on TA sonograms, could be separated on TV sonograms into various stages of PID including pyosalpinx, hydrosalpinx, tubo-ovarian complex, and tubo-ovarian abscess. Thirty-one TA and TV studies were normal despite patients fulfilling strict clinical criteria for PID. The level of severity of PID, as determined at TA sonography, was altered in 28 cases, with medical therapy changed in 23 cases because of additional TV sonographic findings. TV sonography provided superior anatomic detail in the evaluation of patients with PID, demonstrating abnormalities that were not seen at TA sonography in 71% of patients.