Question:

Which of the following answers are true?
1. TOA is a complication of pelvic inflammatory disease.
2. Sonography is the modality of choice in evaluating uterus and ovaries.
3. TOA may demonstrate internal debris and air foci on ultrasound imaging.
4. Every patient with TOA will have fever and leukocytosis.
5. TOA may present on contrast CT images as low attenuating adnexal mass with thick and enhancing walls.





Answer:

The correct answers for the question "Which of the following answers are true?" are:

1. TOA is a complication of pelvic inflammatory disease.

2. Sonography is the modality of choice in evaluating uterus and ovaries.

3. TOA may demonstrate internal debris and air foci on ultrasound imaging.

5. TOA may present on contrast CT images as low attenuating adnexal mass with thick and enhancing walls.



Explanation
1.    TOA is a complication of pelvic inflammatory disease. (Tubo-ovarian abscess is a complication of most likely inadequately treated acute pelvic inflammatory disease. Usually it is a polymicrobial infection with predominance of the anaerobes.)

2.    Sonography is the modality of choice in evaluating uterus and ovaries. (Ultrasound is the most common utilized imaging modality in cases of PID/TOA.  )

3.    TOA may demonstrate internal debris and air foci on ultrasound imaging.  (Ultrasound images usually will show a complex adnexal structure with thick walls and internal echoes,  likely pus with cellular debris.  The presence of air foci within adnexal masses has also been reported)

4.      Not every patient with TOA demonstrates fever and leukocytosis.  (About 20% of patients with TOA may be afebrile or have a normal leukocyte count.)

5.    TOA may present on contrast CT images as low attenuating adnexal mass with thick and enhancing walls. (Some characteristics of CT findings that may be suggestive of TOA include a peripherally enhancing low-density pelvic mass with thick and irregular walls, satellite lesions may be seen adjacent to the main mass which can represent a localized fluid filled fallopian tube.)



From the manuscript:
Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses
Radiology Case. 2010 Feb; 4(2):9-17


This article belongs to the OB/GYN section.




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From the manuscript

Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses

Free full text article: Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses

Abstract
A 36-year-old female presented with constant, worsening left lower quadrant pain without associated fever or vaginal discharge. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large complex cystic structure in the left adnexa with peripheral flow on color Doppler imaging. Given the sonographic appearance and patient symptoms, possibilities included endometrioma or hemorrhagic cyst. Tubo-ovarian abscess (TOA) and other cystic ovarian masses were considered less likely. Two days later, the patient returned with severe pelvic pain as well as fever and leukocytosis. Follow-up ultrasound showed enlargement of the mass and a tubo-ovarian abscess (TOA) was suspected. Ultrasound-guided transvaginal abscess drainage was performed with removal of purulent fluid. The case demonstrates that the radiological features of TOA may mimic those of adnexal cystic masses such as an endometrioma or hemorrhagic cyst. A complementary case is also included which demonstrates similar sonographic findings in a patient with endometrioma. In addition to sonographic imaging, a thorough clinical and laboratory evaluation is important in differentiating these entities. Furthermore, we provide a comprehensive discussion about imaging features of cystic ovarian mass on different imaging modalities.






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