Preliminary Diagnosis: Tubo-ovarian abscess

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

  • Ultrasound (transvaginal is much more sensitive and specific than the transabdominal approach)

II. Describe the advantages and disadvantages of this technique for diagnosis of tubo-ovarian abscess.

Advantages

  • Relatively inexpensive, highly portable imaging modality.

  • Does not expose patients to ionizing radiation.

  • Specific in diagnosing a tubo-ovarian abscess.

  • May help guide treatment and percutaneous intervention.

Disadvantages

  • Highly operator-dependent.

  • Less adept in detailing the surrounding anatomical structures than other imaging modalities.

  • Generally less sensitive than other imaging modalities.

  • Less adept than CT imaging in detailing the primary process and characterizing any secondary complications.

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

  • No specific contraindications to sonographic imaging exist.

IV. What alternative imaging techniques are available?

  • CT of the abdomen and pelvis with IV contrast

  • MR of the abdomen and pelvis with IV contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tubo-ovarian abscess.

CT of the abdomen and pelvis with IV contrast
Advantages

  • Better defines the surrounding anatomical structures than ultrasound

  • More sensitive and specific in diagnosing and characterizing a primary process and defining and detailing any secondary complications.

  • Helps narrow a differential diagnosis and further helps characterize the type and extent of secondary complications.

  • May help guide treatment and therapy.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Less portable than sonographic imaging.

MR of the abdomen and pelvis with IV contrast
Advantages

  • Does not expose patients to ionizing radiation.

  • Highly sensitive and specific in diagnosing a tubo-ovarian abscess.

  • Helps differentiate a multicystic mass from an abnormal fallopian tube.

Disadvantages

  • Expensive

  • Time-consuming

  • Less specific in detailing the surrounding anatomical structures.

  • May be subject to motion and susceptibility-weighted artifact.

  • Less useful in guiding and directing therapy and percutaneous intervention.

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

CT of the abdomen and pelvis with IV contrast

  • May be contraindicated in pregnant patients.

  • IV contrast may be contraindicated in patients with renal failure or contrast allergy

MR of the abdomen and pelvis with IV contrast

  • Contraindicated in patients with non-MR compatible hardware.

  • IV contrast may be contraindicated in patients with renal failure

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