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
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.