In severe cases more testing may be required such as laparoscopy, intra-abdominal bacteria sampling and culturing, or tissue biopsy.Laparoscopy can visualize "violin-string" adhesions, characteristic of Fitz-Hugh–Curtis perihepatitis and other abscesses that may be present.Other imaging methods, such as ultrasonography, computed tomography (CT), and magnetic imaging (MRI), can aid in diagnosis. Blood tests can also help identify the presence of infection: the erythrocyte sedimentation rate (ESR), the C-reactive protein (CRP) level, and chlamydial and gonococcal DNA probes.Nucleic acid amplification tests (NAATs), direct fluorescein tests (DFA), and enzyme-linked immunosorbent assays (ELISA) are highly sensitive tests that can identify specific pathogens present. Serology testing for antibodies is not as useful since the presence of the microorganisms in healthy people can confound interpreting the antibody titer levels, although antibody levels can indicate whether an infection is recent or long-term.Definitive criteria include histopathologic evidence of endometritis, thickened filled Fallopian tubes, or laparoscopic findings. Gram stain/smear becomes definitive in the identification of rare, atypical and possibly more serious organisms. Two thirds of patients with laparoscopic evidence of previous PID were not aware they had PID, but even asymptomatic PID can cause serious harm. Laparoscopic identification is helpful in diagnosing tubal disease; a 65 percent to 90 percent positive predictive value exists in patients with presumed PID.Upon gynecologic ultrasound, a potential finding is tubo-ovarian complex, which is edematous and dilated pelvic structures as evidenced by vague margins, but without abscess formation.
A galactocele (also called lacteal cyst or milk cyst) is a retention cyst containing milk or a milky substance that is usually located in the mammary glands. They can occur in women during or shortly after lactation. They present as a firm mass, often subareolar, and are caused by the obstruction of a lactiferous duct. Clinically, they appear similar to a cyst on examination. The duct becomes more distended over time by epithelial cells and milk. It may rarely be complicated by a secondary infection and result in abscess formation. These cysts may rupture leading to formation of inflammatory reaction and may mimic malignancy. Once lactation has ended the cyst should resolve on its own without intervention. A galactocele is not normally infected as the milk within is sterile and has no outlet through which to become contaminated. Treatment is by aspiration of the contents or by excision of the cyst. Antibiotics are given to prevent infection.Galactoceles may be associated with oral contraceptive use. They have been known to present, although rarely, after Breast augmentation and Breast reduction. References
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Case description and discussion at Harvard.edu