The patient presented with fever (39°C) and abdominal pain. She reported that she had tried to perform an abortion using an iron tool, three days previously.

The patient presented with fever (39°C) and abdominal pain. Physical examination showed signs compatible with acute abdomen syndrome and the laboratory results demonstrated leucocytosis and a high ESR. The patient reported that she was pregnant and had tried to perform an abortion using an iron tool, three days previously.

Pelvic US demonstrated bilateral solid adnexal masses and a small volume of free fluid in the pouch of Douglas. In face of these findings it was considered necessary to perform a pelvic MRI examination. The MRI examination confirmed the US findings, showing a left adnexal mass with a convolved aspect, measuring 10 cm. This was heterogeneous on T1-weighted images and of medium intensity on T2-weighted images. A mass of the same aspect was present on right-hand side. All the lesions showed high enhancement of the wall after paramagnetic contrast administration. There was ascitic fluid in the peritoneal cavity.

Pelvic inflammatory disease (PID) is inflammation and infection of the upper genital tract in women, involving the fallopian tubes, ovaries and surrounding structures.

More than one milion women contract PID each year. Factors associated with PID are: young age, reduced socioeconomic circumstances, African or Afro-Caribbean ethnic origin, lower educational attainment, and recent new sexual partners. It is a polymicrobial infection caused by the ascent of organisms from the cervix; the most common organisms involved are Neisserya gonorrheae and Chlamydia trachomatis, and anaerobic bacteria also seem to be involved.

Diagnosis of PID can be difficult, because it can mimic several other pelvic diseases: ectopic pregnancy, ovarian cyst rupture, ovarian or adnexal torsion, endometriosis, neoplasms, urinary tract infection, and appendicitis.

Transvaginal sonography and MRI have been shown to be accurate in diagnosis. US can demonstrate only ascitic fluid in the peritoneal cavity or, in the most severe cases, can shows adnexial masses with heterogeneous echopattern. MRI findings are non specific; pelvic MRI can demonstrate an adnexal mass, ill defined, containing fluid with various signal intensity. Following administration of gadolinium the wall and the surrounding tissues enhance. Laparoscopy, however, remains the gold standard.