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A tubo-ovarian abscess (TOA) is one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary .
Laparoscopic identification is helpful in diagnosing tubal disease; a 65 percent to 90 percent positive predictive value exists in patients with presumed PID. [25] Upon gynecologic ultrasound, a potential finding is tubo-ovarian complex, which is edematous and dilated pelvic structures as evidenced by vague margins, but without abscess ...
In premenopausal women, adnexal masses include ovarian cysts, ectopic (tubal) pregnancies, benign or malignant tumors, endometriomas, polycystic ovaries, and tubo-ovarian abscess. The most common causes for adnexal masses in premenopausal women include follicular cysts and corpus luteum cysts .
Treatment is with antibiotics and drainage of the abscess; typically guided by ultrasound or CT, through the skin, via the rectum, or transvaginal routes. [3] Occasionally antibiotics may be used without surgery; if the abscess is at a very stage and small. [2] Until sensitivities are received, a broad spectrum antibiotic is generally required. [2]
A hematosalpinx from a tubal pregnancy may be associated with pelvic pain and uterine bleeding. A gynecologic ultrasound will show the hematosalpinx. A hematosalpinx from other conditions may be painless but could lead to uterine bleeding.
On histopathology, paraovarian cysts are generally lined by simple cuboidal epithelium as shown. However, they may have fallopian tubal epithelium or focal papillary projections. [2] Most cysts are small and asymptomatic. [1] Typical sizes reported are 1 to 8 cm in diameter. [1]
During an infertility work-up a hysterosalpingogram, an X-ray procedure that uses a contrast agent to image the fallopian tubes, shows the retort-like shape of the distended tubes and the absence of spillage of the dye into the peritoneum. If, however, there is a tubal occlusion at the utero-tubal junction, a hydrosalpinx may go undetected.
It shows a normal endometrium as a hyperechoid (brighter) band around the cavity, in this case without any focal changes. Sonohysterography is a specialized procedure by which fluid, usually sterile saline (then called saline infusion sonography or SIS ), is instilled into the uterine cavity, and gynecologic sonography performed at the same time.