Transvaginal sonography in suspected pelvic inflammatory disease

Transvaginal sonography was used in the evaluation of clinically suspected pelvic inflammatory disease (PID). A total of 86 patients with PID were examined by transvaginal sonography within 1-3 days, 14 days and 90 days after hospitalization. The diagnosis of PID was confirmed in 37% of patients by laparoscopy, laparotomy or positive cervical culture of Chlamydia trachomatis or Neisseria gonorrhoea. In the remainder, the diagnosis was based on tenderness of the uterus, fever and lower abdominal pain that responded rapidly to antibiotics. At the time of admission, 31% of patients had a thick-walled (> or = 5 mm) echogenic tube raising the suspicion of pyosalpinx or pyo-ovary. During the following 3 months, 52% of patients developed tubes that were thin-walled (< 5 mm) and poorly echogenic, and hydrosalpinx was suspected. At the first transvaginal sonographic examination, 64% showed no adnexal mass, but 16% of these developed suspected hydrosalpinx during the following 3 months. Of the total of 86 patients, 6% exhibited a hydrosalpinx for the first time after 3 months. C-reactive protein concentrations and sedimentation rate values correlated positively with the ultrasonically determined volumes of pyosalpinx/pyoovaries, cul-de-sac fluid and ovaries. Transvaginal sonography appears to be very useful in the diagnosis of suspected PID and is recommended at least 3 months after symptoms have subsided for those patients with an adnexal mass at the time of the acute episode and for infertile patients.