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297 ULTRASOUND CLINICS Ultrasound Clin 2 (2007) 297–309 Ultrasound of Pelvic Inflammatory Disease Mindy M. Horrow, MD, FACR, FAIUMa,b, Shuchi K. Rodgers, MDa,*, Shabbir Naqvi, - Clinical findings Ultrasound findings Acute pelvic inflammatory disease Chronic pelvic inflammatory disease Related findings and differential diagnosis Pelvic inflammatory disease (PID) is an infection of the upper genital tract caused by sexually transmitted disease (STD). In addition to the care required during an acute infection, the sequelae of infertility, ectopic pregnancy, and chronic pelvic pain significantly impact the health care system. Data from 1990 show an estimated cost for care of patients with PID at $4.24 billion annually, with 200,000 hospitalized cases and 1,277,700 outpatient cases. From 1984 to 1990, hospitalizations for PID decreased 25%, with only a slight rise in outpatient visits [1]. More recent estimates from the Centers for Disease Control and Prevention approximate 780,000 new cases of acute PID annually [2]. Although it is unclear if this is a true decrease, or just a result of more outpatient care for patients who have PID, most researchers estimate that there is a significant cohort with unrecognized PID. A study in 2004 found the prevalence of chlamydial infection in young adults in the United States was 4.19%. Women, and in particular black women, had higher rates of 4.74 and 13.95%, respectively [3]. The cost of PID to the - a MD Other imaging: CT Other imaging: MRI Summary References health care system stems more from the major chronic complications than the cost of treating the acute infection. Chronic complications include infertility, ectopic pregnancy, and chronic pelvic pain. A recent study found the average per-person lifetime cost of PID ranges from $1060 to $3180 [4]. Risk factors for PID are related to exposure to STDs and include earlier age at first sexual intercourse, multiple partners, history of prior STD, and use of vaginal douche [5]. There is also increased risk from an intra-uterine device (IUD), but this is limited to the first few weeks after insertion1 [6]. Clinical findings Most cases of PID are caused by Chlamydia trachomatis or Neisseria gonorrhoeae. Co-infections of these organisms and other bacteria, including: Streptococcus species, Escherichia coli, Haemophilus influenza, Bacteroides species, Peptostreptococcus and Peptococcus are common. Normally, the major barrier to the assent of both normal vaginal flora and pathogens a Department of Radiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA b Jefferson Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA * Corresponding author. Department of Radiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098. E-mail address: (S.K. Rodgers). 1 The text of this article is adapted from Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004;20:171–9; with permission. 1556-858X/07/$ – see front matter ª 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.cult.2007.08.008

Ultrasound of Pelvic Inflammatory Disease

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