Fact-sheet: Tuboovarian abscess


Updated on 08/25/2020 at 4:52 PM

Note : 0/10
Share

View all RADEOS cases associated with this fact-sheet

Definition

An advanced stage of upper genital tract infection, tubo-ovarian abscess reflects involvement of the tube and ovary, which are no longer distinguishable from one another.

Clinical features

More common in young, premenopausal women, with multiple partners, IUD use, history of PID (Pelvic Inflammatory Disease).
Pelvic or even abdominal pain, guarding, fever, foul-smelling vaginal discharge, mass or induration on palpation and/or pelvic examination

Laboratory findings

PMN leukocytosis.
Mainly Gonococcus and Chlamydia trachomatis, polymicrobial in 30%.

Ultrasound

A suprapubic AND transvaginal approach is required.

  • Unilateral or bilateral, unilocular or multilocular cystic adnexal mass, with thick heterogeneous hypoechoic content. Wall thick, more or less irregular.
  • Difficulty differentiating the tube from the ovary.
  • Tenderness on ultrasound palpation.
  • Hyperechoic infiltration of the peripheral pelvic fat.
  • Tube and ovary not individually identifiable
  • Color Doppler: hypervascularity of the mass

Look for associated Endometritis (dotted hyperechoic intracavitary uterine gas with posterior attenuation) and/or Douglas pouch abscess, or even more diffuse signs of peritonitis

CT

Unilateral or bilateral, unilocular or multilocular adnexal mass, with hypodense content sometimes containing gas bubbles, with a thick, contrast-enhancing wall.
Infiltration of the adjacent fat, or even of nearby organs, particularly the colon (be careful not to confuse this with a sigmoid abscess).
Pelvic and retroperitoneal lymphadenopathy

MRI

Unilateral or bilateral, unilocular or multilocular adnexal mass. Thickened walls, extension to adjacent organs, particularly digestive organs.
Inflammation of the perilesional fat.

  • T1: hypointense content, with possible peripheral granulation tissue showing spontaneous hyperintensity
  • T2: heterogeneous hyperintensity with a "dirty" or shading appearance
  • Diffusion: hyperintense signal with diffusion restriction, due to the purulent content
  • After gadolinium injection: intense enhancement of the abscess and septa.

Vascular intervention

  • Percutaneous drainage under US or CT guidance if there is certainty about the absence of an underlying cancer, particularly ovarian cancer (a gynecologic cancer is associated in 50% of tubo-ovarian abscesses in postmenopausal women!)

Management

IUD removal.
Antibiotic therapy.
Surgical or percutaneous drainage (provided there is no doubt about an associated gynecologic cancer in postmenopausal women)

Differential diagnosis

Ovarian tumor lesion
Actinomycosis
Perisigmoid abscess or other origin
Adnexal torsion
Hemorrhagic Ovarian cyst
Endometrioma
Paratubal cyst