In cases of salpingitis, the masses lying adjacent to the ovaries were on average 2 to 3 cm in diameter, solid (n = 14), unilocular cystic (n = 4), multilocular cystic (n = 3), or multilocular solid (n = 1), with thick walls and well vascularized at color Doppler [33]. Other specific TVUS findings, including wall thickness >5 mm, cogwheel sign, incomplete septa, and the presence of cul-de-sac fluid, differentiated patients with PID from the control group of hydrosalpinx [32]. Pelvic US has a reported sensitivity of 93% and a specificity of 98% for identification of TOA, a complication of PID. A tubo-ovarian complex is an inflammatory pelvic mass with no pus collection in which adherent, inflamed, edematous ovary, and tubes cannot be separated with the endovaginal probe. TOA demonstrates loss of the normal boundaries of the structures by pus-filled tissue with typical features of complex adnexal mass of varying echogenicity with debris, septations, and irregular margins. Other findings of TOA are pyosalpinx and loculated and speckled echogenic fluid in the cul-de-sac [35]. Evaluation of endometriosis in 104 patients revealed, with respect to rectosigmoid and retrocervical sites, a sensitivity of 98% and 95%, a specificity of 100% and 98%, a PPV of 100% and 98%, an NPV of 98% and 97%, and an accuracy of 99% and 97% with TVUS, demonstrating better results than MRI [36]. A small retrospective case series of 8 pregnant patients with inconclusive findings on MRI and persistent or worsening severe abdominal pain found CT of the abdomen and pelvis useful to diagnose internal hernia, intestinal volvulus, perforation of acute appendicitis, and hemoperitoneum. However, only 75% of these patients received IV contrast for their imaging study [38]. MRI abdomen and pelvis may be appropriate if index of suspicion is high for appendicitis or bowel abnormalities, especially late in pregnancy.
Acute Pelvic Pain in the Reproductive Age Group. In cases of salpingitis, the masses lying adjacent to the ovaries were on average 2 to 3 cm in diameter, solid (n = 14), unilocular cystic (n = 4), multilocular cystic (n = 3), or multilocular solid (n = 1), with thick walls and well vascularized at color Doppler [33]. Other specific TVUS findings, including wall thickness >5 mm, cogwheel sign, incomplete septa, and the presence of cul-de-sac fluid, differentiated patients with PID from the control group of hydrosalpinx [32]. Pelvic US has a reported sensitivity of 93% and a specificity of 98% for identification of TOA, a complication of PID. A tubo-ovarian complex is an inflammatory pelvic mass with no pus collection in which adherent, inflamed, edematous ovary, and tubes cannot be separated with the endovaginal probe. TOA demonstrates loss of the normal boundaries of the structures by pus-filled tissue with typical features of complex adnexal mass of varying echogenicity with debris, septations, and irregular margins. Other findings of TOA are pyosalpinx and loculated and speckled echogenic fluid in the cul-de-sac [35]. Evaluation of endometriosis in 104 patients revealed, with respect to rectosigmoid and retrocervical sites, a sensitivity of 98% and 95%, a specificity of 100% and 98%, a PPV of 100% and 98%, an NPV of 98% and 97%, and an accuracy of 99% and 97% with TVUS, demonstrating better results than MRI [36]. A small retrospective case series of 8 pregnant patients with inconclusive findings on MRI and persistent or worsening severe abdominal pain found CT of the abdomen and pelvis useful to diagnose internal hernia, intestinal volvulus, perforation of acute appendicitis, and hemoperitoneum. However, only 75% of these patients received IV contrast for their imaging study [38]. MRI abdomen and pelvis may be appropriate if index of suspicion is high for appendicitis or bowel abnormalities, especially late in pregnancy.