Preliminary Diagnosis: Salpingitis

I. What imaging technique is first-line for this diagnosis?

Gray scale and Color Doppler sonographic evaluation of the pelvis. Transvaginal offers better resolution compared to a transabdominal approach.

II. Describe the advantages and disadvantages of this technique for diagnosing salpingitis.

Advantages

  • Highly portable and inexpensive imaging modality.

  • Does not expose patients to ionizing radiation.

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Disadvantages

  • Highly operator dependent.

  • Less adept in detecting any secondary complications, such as an abscess.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to sonographic imaging are noted. The transvaginal approach may be uncomfortable for some patients.

IV. What alternative imaging techniques are available?

  • CT with contrast of the pelvis

  • MR with contrast of the pelvis

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing salpingitis.

CT with contrast of the pelvis
Advantages

  • Relatively fast, inexpensive imaging modality.

  • Offers great sensitivity and specificity in detecting any particular complications from salpingitis.

  • Allows for treatment planning, and is helpful in guiding treatment.

Disadvantages

  • Exposes patients to ionizing radiation.

  • May be less sensitive in detailing subtle changes from salpingitis.

MR with contrast of the pelvis
Advantages

  • Does not expose patients to ionizing radiation.

  • Highly sensitive and specific in detecting and detailing complications from salpingitis.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

VI. What are the contraindications for the alternative imaging techniques?

CT with contrast of the pelvis

  • May be contraindicated in pregnant patients.

  • Relative contraindication in patients with renal failure.

  • Relative contraindication in patients with contrast allergy.

MR with contrast of the pelvis

  • May not be performed in patients with non-MR compatible hardware.

  • Gadolinium contrast is contraindicated in patients with a GFR ≤ 30.

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