Advanced Imaging in Pelvic Inflammatory Disease: Revolutionizing Disease Management

Introduction

Pelvic inflammatory disease (PID) is a condition of the female reproductive organs, such as the uterus, fallopian tubes, or ovaries. This is usually caused by sexually transmitted diseases and may spread from the vagina to other organs. The diagnosis of pelvic inflammatory disease may be done by ultrasonography (US) or magnetic resonance imaging (MRI). However, the diagnosis may be challenging and may resemble various other pelvic or abdominal infections.

What Is Pelvic Inflammatory Disease?

Pelvic inflammatory disease is a common and serious infection affecting females. This occurs when certain types of bacteria can spread from the vagina to the reproductive organs, such as the uterus, fallopian tubes, and ovaries. One of the most common reasons for pelvic inflammatory disease is untreated sexually transmitted infections (STIs).

What Is the Epidemiology of Pelvic Inflammatory Disease?

Pelvic inflammatory disease is an infection commonly seen in females and is one of the primary causes of frequent emergency visits to the gynecological department. Every year in the United States, around 2.5 million patients with this condition visit hospitals. This condition is commonly seen in patients aged 15 to 25 years, and people of age more than 35 years have around a 10 to 15 percent chance of developing this condition.

What Is the Pathology of Pelvic Inflammatory Disease?

Pelvic inflammatory disease is an acute infection of the female reproductive organ associated with the ascending spread of microorganisms from the vagina. As the infection spreads from the vagina or cervix to the endometrium, causing endometritis (inflammation and infection of the uterus). From there, it can further spread to the fallopian tubes, leading to problems like salpingitis (inflammation of the fallopian tubes), hydrosalpinx (fluid build-up in the fallopian tube, creating problems in conceiving), and pyosalpinx (abscess formation in the fallopian tube, leading to the spread of infection in the lower genital tract). The PID can also lead to other types of infections such as oophoritis (inflammation of the ovaries), tubo-ovarian abscess, and in severe cases, peritonitis (inflammation of the membrane present on the abdominal wall and covering the abdominal organs).

Pelvic inflammatory disease can result from various causative organisms which include -

Common Causative Agents -

• Chlamydia trachomatis causing pelvic chlamydial infection.

• Neisseria gonorrhoeae causing pelvic gonococcal infection.

• Polymicrobial infection can account for more than 35 percent of cases.

Less Common -

• Mycobacterium tuberculosis causes pelvic tuberculous infection.

• Actinomyces species causing pelvic actinomyces infection.

What Are the Clinical Signs of Pelvic Inflammatory Disease?

The most common clinical sign of pelvic inflammatory disease is lower abdominal pain that is bilateral, is not felt in the urinary tract, and is of less than two weeks duration. Other than that some signs may include -

• Pain ranges from mild to severe.

• Abnormal vaginal discharge of yellow or green color with an unusual odor.

• Nausea and vomiting.

• Pain during sex.

• Bleeding from the vagina during or after intercourse.

• Chills or fever.

• Burning while peeing.

• Irregular periods or spotting or cramping throughout the month.

Moreover, upon physical examination of the abdomen, diffuse tenderness and decreased bowel sounds may be noticed. Pelvic examination PID can be confirmed by the chandelier sign, meaning endocervical discharge and cervical motion tenderness.

How to Diagnose Pelvic Inflammatory Disease?

There is specifically no accurate test to diagnose pelvic inflammatory disease and healthcare professionals will check for multiple factors to confirm the diagnosis such as

• Medical History - Patients would be asked about their sexual habits and history of any sexually transmitted diseases.

• Physical Examination - The pelvic region will be examined by the healthcare professional for swelling and tenderness. The fluid samples may also be taken from the vagina and cervix to check for the presence of microorganisms.

• Blood and Urine Tests - These tests may also help detect any sexually transmitted disease or measure the count of white blood cells to confirm the infection.

• Imaging Tests - Ultrasound, MRI (magnetic resonance imaging), or CT (computed tomography) can be done to check the images of the reproductive organs and to check for any abnormalities.

The diagnostic criteria for pelvic inflammatory disease according to the Centers for Disease Control (CDC) guidelines is -

• Fever more than 38.3 degrees Celsius.

• Abnormal cervical or vaginal mucopurulent discharge.

• White blood cells on saline microscopy.

• Elevated sedimentation rate and/or C-reactive protein.

• Positive test results for the presence of Gonococcus (N. gonorrhoeae) or C trachomatis.

The minimum diagnostic criteria include -

• Uterine tenderness or adnexal tenderness or cervical motion tenderness.

What Are the Findings in Imaging Tests?

Imaging tests alone are not the ideal diagnostic tests for pelvic inflammatory disease. In the initial stage of the infection, there may be no findings, and only in the very late stage of infection, some inflammatory changes may be detected.

Ultrasound is usually the first choice of test done in cases of lower abdominal pain. During this test some of the following findings such as

• Indistinct uterine margins.

• Fallopian tube thickening.

• Increased ovarian volumes

• Increased thickness and vascularity of the endometrium.

In the computed tomography scan the following findings can be seen which include -

• Presence of tubular adnexal mass.

• Fallopian tube thickening of more than five millimeters.

• Indistinct uterine border.

• Thickening of the uterosacral ligaments.

• Lymphadenopathy (enlargement of lymph nodes).

• Presence of fluid (cul-de-sac).

In the case of MRI (magnetic resonance imaging), an ill-defined adnexal mass containing fluid can be seen.

What Are the Risk Factors of Pelvic Inflammatory Disease?

The risk factors include -

• Age of between 15 to 25 years.

• Multiple sexual partners.

• Poor contraceptive habits.

• Frequent sex (six times per week or more).

What Can Happen if PID Is Not Treated?

Pelvic inflammatory disease can be easily controlled by following an antibiotic course. However, if it is not treated on time and is ignored it can lead to various complications which include -

• Long-standing pain in the lower abdomen (chronic pelvic pain).

• Trouble getting pregnant (infertility).

• Abnormal pregnancy in the fallopian tube instead of the uterus (ectopic pregnancy).

• Infection in the ovary and fallopian tube (tubo-ovarian abscess).

Conclusion

Pelvic inflammatory disease is a common infection seen in women of reproductive age. The prognosis of this condition depends upon the early diagnosis and the following treatment plan. PID is mostly detected upon clinical examination, and imaging tests can help detect the symptoms associated with it leading to its diagnosis.