EURORAD ESR

Case 13122

Tubo-ovarian abscess: MRI findings and role

Author(s)
Tonolini Massimo, M.D.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 45 year(s)
 
 
  • Figure 1
    Transvaginal ultrasound at admission

    A complex multiloculated cystic lesion measuring 55x39x35 mm (Calipers) was seen occupying the right adnexal region. Additional findings included minimal fluid in the peritoneal cul-de-sac, normal-sized postmenopausal...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 2
    Unenhanced MRI (the patient refused intravenous contrast due to allergy)
     

    Multiplanar T2-weighted images (a...f) confirmed normal-sized postmenopausal uterus (short arrows in a).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Multiplanar T2-weighted images confirmed a 6x4x3.5 cm multiloculated cystic right adnexal mass (arrows) with predominantly fluid signal, septations and minimally thickened peripheral rim (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Multiplanar T2-weighted images confirmed a 6x4x3.5 cm multiloculated cystic right adnexal mass (arrows) with predominantly fluid signal, septations and minimally thickened peripheral rim (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Multiplanar T2-weighted images confirmed a 6x4x3.5 cm multiloculated cystic right adnexal mass (arrows) with predominantly fluid signal, septations and minimally thickened peripheral rim (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    The multiloculated cystic right adnexal mass (arrows) had an identifiable fluid-filled ventral tubular portion (arrowheads) consistent with dilated fallopian tube, which favoured infection over tumour. Note septations...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    The multiloculated cystic right adnexal mass (arrows) had an identifiable fluid-filled ventral tubular portion (arrowheads) consistent with dilated fallopian tube, which favoured infection over tumour. Note septations...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Additonally, fat-suppressed heavily T2-weighted images (g, h) showed minimal effusion in the peritoneal cul-de-sac (*), extensive hypersignal (+) consistent with parametrial oedema.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Additonally, fat-suppressed heavily T2-weighted images (g, h) showed minimal effusion in the peritoneal cul-de-sac (*), extensive hypersignal (+) consistent with parametrial oedema.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Unenhanced T1-weighted images (i, fat-suppressed j) showed the complex multiloculated right adenxal mass (arrows) with heterogeneous, predominantly low signal intensity, without haemorrhagic portions.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    Unenhanced T1-weighted images (i, fat-suppressed j) showed the complex multiloculated right adenxal mass (arrows) with heterogeneous, predominantly low signal intensity, without haemorrhagic portions.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 3
    Transvaginal ultrasound follow-up a week later

    At discharge, follow-up ultrasound at revealed decreased size (32x36x39 mm) and volume (23.5 ml compared to 36 ml initially) of the complex right adnexal mass, with increased fluid-like anechoic regions; disappearance...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
A complex multiloculated cystic lesion measuring 55x39x35 mm (Calipers) was seen occupying the right adnexal region. Additional findings included minimal fluid in the peritoneal cul-de-sac, normal-sized postmenopausal uterus and left ovary.
 
Multiplanar T2-weighted images (a...f) confirmed normal-sized postmenopausal uterus (short arrows in a).
 
Multiplanar T2-weighted images confirmed a 6x4x3.5 cm multiloculated cystic right adnexal mass (arrows) with predominantly fluid signal, septations and minimally thickened peripheral rim (thin arrows).
 
Multiplanar T2-weighted images confirmed a 6x4x3.5 cm multiloculated cystic right adnexal mass (arrows) with predominantly fluid signal, septations and minimally thickened peripheral rim (thin arrows).
 
Multiplanar T2-weighted images confirmed a 6x4x3.5 cm multiloculated cystic right adnexal mass (arrows) with predominantly fluid signal, septations and minimally thickened peripheral rim (thin arrows).
 
The multiloculated cystic right adnexal mass (arrows) had an identifiable fluid-filled ventral tubular portion (arrowheads) consistent with dilated fallopian tube, which favoured infection over tumour. Note septations and minimally thickened peripheral rim (thin arrows).
 
The multiloculated cystic right adnexal mass (arrows) had an identifiable fluid-filled ventral tubular portion (arrowheads) consistent with dilated fallopian tube, which favoured infection over tumour. Note septations and minimally thickened peripheral rim (thin arrows).
 
Additonally, fat-suppressed heavily T2-weighted images (g, h) showed minimal effusion in the peritoneal cul-de-sac (*), extensive hypersignal (+) consistent with parametrial oedema.
 
Additonally, fat-suppressed heavily T2-weighted images (g, h) showed minimal effusion in the peritoneal cul-de-sac (*), extensive hypersignal (+) consistent with parametrial oedema.
 
Unenhanced T1-weighted images (i, fat-suppressed j) showed the complex multiloculated right adenxal mass (arrows) with heterogeneous, predominantly low signal intensity, without haemorrhagic portions.
 
Unenhanced T1-weighted images (i, fat-suppressed j) showed the complex multiloculated right adenxal mass (arrows) with heterogeneous, predominantly low signal intensity, without haemorrhagic portions.
 
At discharge, follow-up ultrasound at revealed decreased size (32x36x39 mm) and volume (23.5 ml compared to 36 ml initially) of the complex right adnexal mass, with increased fluid-like anechoic regions; disappearance of peritoneal cul-de-sac effusion.
 
 
 
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