Pelvic Inflammatory Disease/Pyosalpinx


Molly Jonna, MS4 and Jennifer Lim-Dunham, M.D.


What is pelvic inflammatory disease?

What are the useful imaging modalities in evaluating PID?

What is the utility of each procedure?

Appropriateness Criteria

Link to women’s imaging recommendations:

Link to imaging criteria for acute pelvic pain in the reproductive age group:

Link to imaging recommendations for acute abdominal pain and fever or suspected abdominal abscess: AcuteAbdominalPainFeverSuspectedAbdominalAbscess .pdf


What are the imaging findings of PID?



What is the procedure of choice?

What are the risk factors for acquiring PID?

The risk factors for acquiring PID are similar to those for acquiring an STD and include:

Factors that potentially facilitate PID include:

What is the clinical setting when you will consider PID?

Minimum criteria needed for clinical diagnosis:

Additional criteria, which increase the specificity of the diagnosis

Take Home Points:



Image 1

Left pyosalpinx. The left fallopian tube, which is marked by the red and green calipers, is dilated and contains anechoic, simple fluid as well echogenic debris representing pus. The white arrow is pointing towards a fluid-fluid level. The black arrow is pointing to an anechoic cyst within the left ovary, which is adjacent to but separate from the dilated fallopian tube.

Image 2

Left pyosalpinx. The green calipers mark the dilated fallopian tube filled with anchoic fluid and echogenic pus. The white arrow is pointing towards a fluid-fluid level.

Image 3

Right tubo-ovarian abscess. The black arrow points towards a hypoechoic structure representing a combined complex collection encompassing both fallopian tube and ovary. Note that the abscess, marked by the green calipers, is characterized by a thick wall and central echogenic fluid representing pus.

Image 4

Right tubo-ovarian abscess. Color Doppler shows that there is no flow within the hypoechoic right adnexal structure ( white arrow ) that represents the abscess. This indicates that the structure is a fluid filled mass as opposed to a solid mass.

Helpful links with Additional Imaging:


  2. - a powerpoint of information and images that you can scroll through
  3.  - article with several images included, this is also linked in the references section



  1. Livengood, C. H., & Chacko, M. R. (2012). Clinical features and diagnosis of pelvic inflammatory disease. In N. Hynes & A. Bloom (Eds.), UpToDate. Retrieved from
  2. Rezvani, M., & Shaaban, A. M. (2011). Fallopian tube disease in the nonpregnant patient. RadioGraphics, 31, 527-548. Retrieved from
  3. Sam, J. W., Jacobs, J. E., & Birnbaum, B. A. (2002). Spectrum of ct findings in acute pyogenic pelvic inflammatory disease. RadioGraphics, 22, 1327-1334. Retrieved from