Computed Tomography Features of Pelvic Inflammatory Disease Caused by Chlamydia trachomatis and Neisseria gonorrhoeae.

OBJECTIVE

This study aimed to characterize computed tomography (CT) findings in women with pelvic inflammatory disease (PID) due to polymerase chain reaction-confirmed Chlamydia trachomatis or Neisseria gonorrhoeae and to identify imaging patterns that may assist diagnosis in the emergency setting.

METHODS

We conducted a retrospective study of 44 female patients who underwent abdominal or pelvic CT in the gynecology emergency department and tested positive for C. trachomatis, N. gonorrhoeae , or both. Images on CT were reevaluated by 2 radiologists for signs consistent with PID. Imaging findings were compared across 3 analyses: (1) cases correctly versus incorrectly diagnosed in the original radiology report, (2) concordant versus discordant interpretations between original and retrospective reads, and (3) differences between infections caused by C. trachomatis and N. gonorrhoeae.

RESULTS

Computed tomographic features consistent with PID were present in 77.3% of cases. The most frequent findings were fat stranding (86.4%), free pelvic fluid (79.5%), and peritoneal thickening (72.7%). Tubo-ovarian abscesses occurred in 36.4% and were always correctly identified. Subtle peritoneal thickening was more frequent in discordant interpretations (100% vs. 63%, P  = 0.01). Fallopian tube thickening was more common in C. trachomatis than N. gonorrhoeae infection (49% vs. 11%, P  = 0.013).

CONCLUSIONS

Computed tomography often reveals the characteristic features of PID even when the condition is not clinically suspected. Subtle radiologic findings-particularly peritoneal thickening or enhancement and pelvic fat stranding-are often overlooked during emergency evaluation. Increased awareness of these signs may facilitate earlier recognition and management.