[Value of ultrasonics in acute pelvic infections]

Sonograms performed in 228 women admitted for acute pelvic infection has enabled to find a normal image in 39.9% of the cases. In order of frequency, the abnormalities include: endometrial alterations (31.1%), one (or several) pelvic masses (25.9%) and a collection in the Douglas cul-de-sac (22.8%). The main advantage of the examination in the acute phase is the diagnosis and the study of the mass structure: most of the time, it concerns a "mixed" or heterogeneous aspect, for all of the images of a mass, as well as for images corresponding to a tubo-adnexal collection. The major critic of this examination is the lack of specificity of the images which are very diversified. The risk of confusion with another pathology (gynecological or, exceptionally gastro-intestinal) must be decreased with an examination of good quality and comparison with the clinical context. The presumption of a tubo-adnexal collection cannot, in most cases, be established with certainty. However, the Echography guides the diagnosis by showing an anechogenous image or a particular aspect (Douglas abscess, huge septated images of sequelae) and remains more reliable than clinic to detect the mass (44% of false negative, clinically) and follow the evolution of the disease. The therapeutic advantage is also mentioned, but the tap of an abscess under sonogram guidance is seldom performed.