From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520.
Radiographics. 2016 Sep-Oct;36(5):1579-96. doi: 10.1148/rg.2016150202.
Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.
盆腔炎性疾病（PID）是一种常见的医学问题，每年诊断出近 100 万例。从历史上看，PID 是一种临床诊断，辅以超声（US）或磁共振成像（MR）的发现。然而，PID 的诊断具有挑战性，因为临床表现可能与其他盆腔和腹部过程相似。鉴于临床表现不具特异性，通常首先进行计算机断层扫描（CT）检查。早期和晚期 PID 的 CT 一般表现包括子宫骶韧带增厚、盆腔脂肪条索状混浊、反应性淋巴结病和盆腔游离液体。识别这些发现，以及宫颈炎、子宫内膜炎、急性输卵管炎、卵巢炎、输卵管积脓、输卵管积水、输卵管卵巢脓肿和子宫积脓的表现，对于及时准确的诊断至关重要。PID 的晚期并发症包括输卵管损伤导致不孕和异位妊娠、子宫和/或输卵管卵巢脓肿破裂引起的腹膜炎、腹膜粘连导致肠梗阻和/或肾盂积水、右上腹炎症（Fitz-Hugh-Curtis 综合征）和脓毒性血栓性静脉炎。CT 对这些晚期表现的识别也有助于正确的患者管理。在 CT 检查中，仔细评估常见的 PID 类似疾病，如子宫内膜异位症、附件扭转、破裂出血性卵巢囊肿、附件肿瘤、阑尾炎和憩室炎，对于避免误诊、延迟治疗和不必要的手术非常重要。与补充成像检查（如 US 和 MR 成像）的结果进行关联有助于确立明确的诊断。（©）RSNA，2016 年。
