Preliminary Diagnosis: Tubo-ovarian abscess
I. What imaging technique is first-line for this diagnosis
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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
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Relatively inexpensive, highly portable imaging modality.
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Does not expose patients to ionizing radiation.
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Specific in diagnosing a tubo-ovarian abscess.
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May help guide treatment and percutaneous intervention.
Disadvantages
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Highly operator-dependent.
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Less adept in detailing the surrounding anatomical structures than other imaging modalities.
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Generally less sensitive than other imaging modalities.
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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?
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No specific contraindications to sonographic imaging exist.
IV. What alternative imaging techniques are available?
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CT of the abdomen and pelvis with IV contrast
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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
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Better defines the surrounding anatomical structures than ultrasound
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More sensitive and specific in diagnosing and characterizing a primary process and defining and detailing any secondary complications.
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Helps narrow a differential diagnosis and further helps characterize the type and extent of secondary complications.
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May help guide treatment and therapy.
Disadvantages
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Exposes patients to ionizing radiation.
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Less portable than sonographic imaging.
MR of the abdomen and pelvis with IV contrast
Advantages
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Does not expose patients to ionizing radiation.
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Highly sensitive and specific in diagnosing a tubo-ovarian abscess.
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Helps differentiate a multicystic mass from an abnormal fallopian tube.
Disadvantages
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Expensive
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Time-consuming
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Less specific in detailing the surrounding anatomical structures.
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May be subject to motion and susceptibility-weighted artifact.
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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
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May be contraindicated in pregnant patients.
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IV contrast may be contraindicated in patients with renal failure or contrast allergy
MR of the abdomen and pelvis with IV contrast
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Contraindicated in patients with non-MR compatible hardware.
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IV contrast may be contraindicated in patients with renal failure
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