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575
Pictorial
CT Findings Andrew
Pelvic
in Tuboovarian
C. Wilbur,1
Robert
I. Aizenstein,
inflammatory
disease
with
Abscess
and Tracy
tuboovarian
abscess
E. Napp
can
wide range of radiologic abnormalities. Although the diagnosis of tuboovarian abscess is usually straighiforward and is based on clinical and sonographic findings, unusual or unsuspected cases may be confused with other pelvic or abdominal diseases. The purpose of this essay is to illustrate the CT findings in tuboovarian abscess. cause
Essay
a
ever, if PID is not suspected, the clinical and radiologic diagnosis of tuboovarian abscess may be difficult. The CT scans presented in this essay are from six cases of tuboovanan abscess not suspected before CT was done. The diagnosis of tuboovarian abscess was confirmed by surgery in five cases and by clinical course in one case. Common abnormalities
shown
on
CT
scans
in tuboovarian
abscess
are
illustrated. Tuboovarian abscess is a well-recognized complication of pelvic inflammatory disease (PID) reported to occur in as many as one third of patients hospitalized for acute salpingitis [1]. Each year approximately one million women have symptomatic PID. More than 275,000 women are hospitalized annually for PID, and more than 100,000 surgical procedures are performed [2]. Moreover, the prevalence of tuboovarian abscess is projected to increase, paralleling the rise in sexually transmitted diseases. PID results from an ascending vaginal or cervical infection that progresses to endometritis followed by salpingitis. Inadequately
treated
PID may lead to infection
of the ovary,
with
resultant unilateral or bilateral tuboovarian abscesses. Cultures usually reveal a polymicrobial infection with a preponderance of anaerobes [1]. Frequently, adhesions develop within
the fallopian
tubes,
salpinx.
Although
localized
to the ovary
causing
tuboovarian
tubal
obstruction
abscesses
and fallopian
and pyo-
generally
tubes,
rupture
remain
can result
in a life-threatening generalized peritonitis. The signs and symptoms of uncomplicated salpingitis and tuboovarian abscess are similar. Differentiation requires exclusion or confirmation of an inflammatory pelvic mass (Fig. 1). This distinction is generally made with sonography. HowReceived July 22, 1991 ; accepted 1
All authors: Department
AJR 158:575-579,
March
after revision
of Aadiology,
lkiiversity
October
Pelvic
Mass
Abdominal
radiographs
it showed
a septated,
the cul-de-sac, endometrial
echoes
also be useful guiding
a soft-tissue
therapeutic
cystic
pelvic
mass.
uterine margins,
are ancillary
in assessing
mass
in the
aspiration
findings.
response
Free fluid in
and loss of midline Sonography
to treatment
and catheter
may
and in
drainage.
CT is best used as an adjunct to sonography in atypical cases of tuboovarian abscess. Several CT features suggest the diagnosis of tuboovarian abscess in the proper clinical context
[4]. Although
18, 1991.
0 American Roentgen
mostly
indistinct
of Illinois at Chicago, 1740 W. Taylor, Chicago, IL 60612.
1992 0361-803x/92/1583-0575
may show
pelvis. In the series reported by Phillips [3] in 1974, this finding was present in 36 (82%) of 44 patients with tuboovarian abscess who had plain radiographs. An adynamic ileus may be present also. Sonography is the imaging technique most frequently used to confirm a suspected diagnosis of tuboovanan abscess. Typically, sonograms show an adnexal or retroutenne mass that may be cystic, solid, or complex. In our series, sonography was used to detect hypoechoic pelvic masses in three of six patients with tuboovanan abscess. In the remaining three,
Ray Society
nonspecific,
the most
frequent
finding
WILBUR
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
576
Fig.
1.-Tuboovarian
abscess.
CT
Fig 2.-Tuboovarian shows partially septated,
scan
shows thick-walled, fluid-density mass in right adnsxal region (A). Fluid in cul-de-sac posterior to uterus (U) (curved arrow) indents perirectal space
(straight
ET AL.
abscess. CT scan fluid-density mass in
left anterior pelvis (m) Fluid-filled hire to right of uterine fundus confirmed pyosalpinx (p).
arrow).
AJR:158, March 1992
tubular strucis a surgically
Fig. 3.-Uncomplicated pelvic inflammatory with nonspecific CT findings. CT scan shows a small cystic left adnexal mass (arrowdisease
heads) and thickened, but nondisplaced mesosalpinx (arrows). Thickening of mesosalpinx suggests adnexal inflammation, but small size of
cystic mass with no loculation favors
an uninfected
physiologic
or thickened cyst. Clinical
walls and
sonographic correlation is essential in such cases. Uterus contains an intrauterine contraceptive device (IUD). Frequency of IUD use in patients with tuboovarian abscess has been reported as 2054% [1]. In our series, an IUD was present or had recently been removed in two of six patients.
Fig. 4.-Bilateral
tuboovanan
abscesses.
CT
scan shows multiloculated fluid collection causing anterior displacement of a thickened right mesosalpinx (arrows).
Fig. 5.-Left tuboovarian abscess. CT scan shows anterior displacement of left mesosalpinx (arrows) by septated fluid collection.
(in all six of our patients) is a thick-walled, fluid-density mass in an adnexal location (Fig. 1 ). Internal septations are cornmon. Pyosalpinx may be considered when a tubular fluiddensity adnexal mass is seen (Fig. 2). This finding can also
be present when hydrosalpinx previous
tubal
sterilization,
is caused by obstructing or previous
episodes
with
nonspecific
CT features
is found
in a patient
correlations are important to of tuboovarian abscess (Fig.
3).
tumor,
of PID [4].
Internal gas bubbles are the most specific radiologic sign of abscess, but this sign is unusual in tuboovarian abscesses and was not present in any of our six cases. When an adnexal mass
PID, clinical and sonographic confirm or exclude a diagnosis
with
Anterior Because superiorly
Displacement
of the Mesosalpinx
the mesosalpinx normally arches anteriorly and to the mesoovarium, expansion of the ovary or mesoovariurn by inflammatory or neoplastic processes dis-
March
Fig.
6.-Bilateral
displaced enlng
CT OF TUBOOVARIAN
1992
AJR:158,
577
ABSCESS
abscesses with CT scan shows thickdIsplacement of both right and tuboovarian
mesosalpinges.
and anterior
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
left mesosalplnges.
7-Drawing of paramedian sagittal section broad ligament ft = fallopian tube, mx = mesosalplnx, o = ovary, me = mesovarlum, mm = mesometrlum. Fig.
through
Fig. 8.-CT scan shows thickening of uterosacral ligaments (arrows) in a patient with bilateral
tuboovarian abscesses. tenuation of edematous
Fig. 9.-CT
scan
Also note increased penrectal
shows
at-
fat.
normal
uterosacral
hg-
aments (arrows).
places the mesosalpinx anteriorly (Figs. 4-7). Anterior displacement of the mesosalpinx by a pelvic mass, therefore, suggests ovarian or tubal origin [4]. Anterior displacement and thickening of the ipsilateral mesosalpinx in tuboovarian abscess has been described [4]. This combination of displacement and thickening was present in all of our patients. Although
highly
suggestive
for tuboovarian
abscess
with
pelvic
Thickening
endometriosis
of Uterosacral
of adnexal
disease,
it is not specific
and may also be observed or ovarian
in patients
neoplasm.
adnexal
or tubal
Ligaments
disease
may cause
CT (Fig. 9).
Rectosigmoid
Involvement
Because the inflammation and fibrosis associated with tuboovarian abscess tend to spread posteriorly into the penrectal and presacral fat, barium enema frequently shows extrinsic rectosigmoid involvement. The mucosa appears intact, with serrated or spiculated margins. A long segment of
The uterosacral ligaments represent localized condensation of subserous endopelvic tissue. They are contiguous with the uterus and broad ligament and course posteriorly to join the deep fascia over the sacrum. Posterior extension of inflammatory
finding was present in four of our patients. The normal thickness of the uterosacral ligaments on CT scans has not been established. As with other fascial planes, the normal uterosacral ligaments are symmetrically very thin and distinct on
thickening
of the
uterosacral ligaments and increased density of the presacral and penrectal fat [4]. Uterosacral ligament thickening, in conjunction with anterior displacement of the mesosalpinx, provides additional evidence for adnexal disease (Fig. 8). This
tapered narrowing is typical. Phillips [3] found constriction of the sigmoid colon in 28 (88%) of 32 patients with tuboovarian abscess
who
had barium
enema.
On CT scans,
luminal
nar-
rowing, infiltration of perirectal fat, and indistinct borders between the pelvic mass and bowel suggest rectosigmoid involvement (Figs. 1 0 and 1 1). These findings were present in all of our patients. Fistulous communication between the tuboovarian abscess and sigmoid colon is a rare complication
[3].
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
578
WILBUR
,
--
March
1992
-
Fig. 10.-CT scan shows poorly defined fluid soft-tissue-density pelvic mass surrounding rectosigmoid area. MargIns between mass and bowel are IndIstinct Thickening of uterosacral ligament (arrows) and edema of presacral fat are also present.
and
AJR:158,
-
,,#{248}z
-.
ET AL.
Fig. I 1.-Tuboovarian abscess. CT scan shows large, thick-walled fluid collection in right side of pelvis causing extrinsic mass effect and displacemont of rectosigmoid to left. Also note left hydroureter (arrow).
Fig.
phrosis
12.-CT scan and paraaortic
shows bilateral hydronelymphadenopathy
due to
tuboovarlan abscess. (Same patient as
In Fig.
2.)
Fig. 13.-Endometriosis. CT scan shows multiloculated fluid collection near left uterine fundus simulating tuboovarlan abscess. Fluid is also prosent within cul-de-sac.
Fig. 14.-Pelvic abscess in patient with Crohn’s CT scan shows thick-walled, fluid-density mass near right adnexa. Note normal attenuation of perirectal and presacral fat No evidence of ureteral constriction or of mesosalpinx displacedisease.
mont is seen.
Ag 15.-Serous
cystadenocarcinoma.
CT scan
shows large, septated pelvic mass containing both fluid and soft-tissue-density components. Mahignant ovarian neoplasm may appear cystic and
.4:.
must be included in difterential diagnosis benign or inflammatory pelvic disease.
of cystic
Fig. 16.-Corpus luteum cyst. CT scan shows homogeneous, thin-walled, nonseptated left adnexal cystic mass. Note normal attenuation of perirectal
fat and absence
of hydroureter.
AJR:158,
March
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
Ureteral
CT OF TUBOOVARIAN
1992
Differential
Involvement
The
pelvic
ureters
form
ovarian spasm served
fossa
and, as such,
the posterior
boundary
may be compressed
of the
or undergo
in patients with tuboovarian abscess. Phillips [3] obproximal ureteral dilatation in 17 (39%) of 44 patients with tuboovanan abscess who had excretory urography. CT may show bilateral or unilateral hydronephrosis and hydroureter (Fig. I 2). The point of ureteral obstruction is usually at or just below the pelvic brim.
579
ABSCESS
Diagnosis
The CT differential diagnosis of tuboovarian abscess includes endornetriosis, ovarian tumors and cysts, and abscesses from other sources within the pelvis and abdomen (Figs. 13-16). Imaging findings of endornetriosis in particular can mimic those of tuboovarian abscess. In the abscence of internal gas bubbles, tuboovarian abscess is radiologically indistinguishable from pelvic endometriosis.
REFERENCES
DV, Sweet AL. Current trends in the diagnosis and treatment tuboovanan abscess. Am J Obstet Gynecol 1985;1 51:1098-1101 2. Centers for Disease Control. Pelvic inflammatory disease: guidelines prevention and management. MMWR 1991;40(AR-5): 1-25 1 . Landers
Paraaortic
Lymphadenopathy
The lymphatic parallels
drainage
the gonadal
veins.
of the ovaries As a result,
and fallopian
inflammatory
tubes
paraaor-
tic lymphadenopathy occurs near the level of the renal hila (Fig. 12). This finding was present in three of our patients.
3. Phillips JC. A spectrum of radiologic abnormalities abscess. Radiology 1974;1 10:307-311 4. Wilbur A. Computed tomography of tuboovarian Assist Tomogr 1990:14:625-628
of
for
due to tubo-ovarian abscesses.
J Comput
575
Pictorial
CT Findings Andrew
Pelvic
in Tuboovarian
C. Wilbur,1
Robert
I. Aizenstein,
inflammatory
disease
with
Abscess
and Tracy
tuboovarian
abscess
E. Napp
can
wide range of radiologic abnormalities. Although the diagnosis of tuboovarian abscess is usually straighiforward and is based on clinical and sonographic findings, unusual or unsuspected cases may be confused with other pelvic or abdominal diseases. The purpose of this essay is to illustrate the CT findings in tuboovarian abscess. cause
Essay
a
ever, if PID is not suspected, the clinical and radiologic diagnosis of tuboovarian abscess may be difficult. The CT scans presented in this essay are from six cases of tuboovanan abscess not suspected before CT was done. The diagnosis of tuboovarian abscess was confirmed by surgery in five cases and by clinical course in one case. Common abnormalities
shown
on
CT
scans
in tuboovarian
abscess
are
illustrated. Tuboovarian abscess is a well-recognized complication of pelvic inflammatory disease (PID) reported to occur in as many as one third of patients hospitalized for acute salpingitis [1]. Each year approximately one million women have symptomatic PID. More than 275,000 women are hospitalized annually for PID, and more than 100,000 surgical procedures are performed [2]. Moreover, the prevalence of tuboovarian abscess is projected to increase, paralleling the rise in sexually transmitted diseases. PID results from an ascending vaginal or cervical infection that progresses to endometritis followed by salpingitis. Inadequately
treated
PID may lead to infection
of the ovary,
with
resultant unilateral or bilateral tuboovarian abscesses. Cultures usually reveal a polymicrobial infection with a preponderance of anaerobes [1]. Frequently, adhesions develop within
the fallopian
tubes,
salpinx.
Although
localized
to the ovary
causing
tuboovarian
tubal
obstruction
abscesses
and fallopian
and pyo-
generally
tubes,
rupture
remain
can result
in a life-threatening generalized peritonitis. The signs and symptoms of uncomplicated salpingitis and tuboovarian abscess are similar. Differentiation requires exclusion or confirmation of an inflammatory pelvic mass (Fig. 1). This distinction is generally made with sonography. HowReceived July 22, 1991 ; accepted 1
All authors: Department
AJR 158:575-579,
March
after revision
of Aadiology,
lkiiversity
October
Pelvic
Mass
Abdominal
radiographs
it showed
a septated,
the cul-de-sac, endometrial
echoes
also be useful guiding
a soft-tissue
therapeutic
cystic
pelvic
mass.
uterine margins,
are ancillary
in assessing
mass
in the
aspiration
findings.
response
Free fluid in
and loss of midline Sonography
to treatment
and catheter
may
and in
drainage.
CT is best used as an adjunct to sonography in atypical cases of tuboovarian abscess. Several CT features suggest the diagnosis of tuboovarian abscess in the proper clinical context
[4]. Although
18, 1991.
0 American Roentgen
mostly
indistinct
of Illinois at Chicago, 1740 W. Taylor, Chicago, IL 60612.
1992 0361-803x/92/1583-0575
may show
pelvis. In the series reported by Phillips [3] in 1974, this finding was present in 36 (82%) of 44 patients with tuboovarian abscess who had plain radiographs. An adynamic ileus may be present also. Sonography is the imaging technique most frequently used to confirm a suspected diagnosis of tuboovanan abscess. Typically, sonograms show an adnexal or retroutenne mass that may be cystic, solid, or complex. In our series, sonography was used to detect hypoechoic pelvic masses in three of six patients with tuboovanan abscess. In the remaining three,
Ray Society
nonspecific,
the most
frequent
finding
WILBUR
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
576
Fig.
1.-Tuboovarian
abscess.
CT
Fig 2.-Tuboovarian shows partially septated,
scan
shows thick-walled, fluid-density mass in right adnsxal region (A). Fluid in cul-de-sac posterior to uterus (U) (curved arrow) indents perirectal space
(straight
ET AL.
abscess. CT scan fluid-density mass in
left anterior pelvis (m) Fluid-filled hire to right of uterine fundus confirmed pyosalpinx (p).
arrow).
AJR:158, March 1992
tubular strucis a surgically
Fig. 3.-Uncomplicated pelvic inflammatory with nonspecific CT findings. CT scan shows a small cystic left adnexal mass (arrowdisease
heads) and thickened, but nondisplaced mesosalpinx (arrows). Thickening of mesosalpinx suggests adnexal inflammation, but small size of
cystic mass with no loculation favors
an uninfected
physiologic
or thickened cyst. Clinical
walls and
sonographic correlation is essential in such cases. Uterus contains an intrauterine contraceptive device (IUD). Frequency of IUD use in patients with tuboovarian abscess has been reported as 2054% [1]. In our series, an IUD was present or had recently been removed in two of six patients.
Fig. 4.-Bilateral
tuboovanan
abscesses.
CT
scan shows multiloculated fluid collection causing anterior displacement of a thickened right mesosalpinx (arrows).
Fig. 5.-Left tuboovarian abscess. CT scan shows anterior displacement of left mesosalpinx (arrows) by septated fluid collection.
(in all six of our patients) is a thick-walled, fluid-density mass in an adnexal location (Fig. 1 ). Internal septations are cornmon. Pyosalpinx may be considered when a tubular fluiddensity adnexal mass is seen (Fig. 2). This finding can also
be present when hydrosalpinx previous
tubal
sterilization,
is caused by obstructing or previous
episodes
with
nonspecific
CT features
is found
in a patient
correlations are important to of tuboovarian abscess (Fig.
3).
tumor,
of PID [4].
Internal gas bubbles are the most specific radiologic sign of abscess, but this sign is unusual in tuboovarian abscesses and was not present in any of our six cases. When an adnexal mass
PID, clinical and sonographic confirm or exclude a diagnosis
with
Anterior Because superiorly
Displacement
of the Mesosalpinx
the mesosalpinx normally arches anteriorly and to the mesoovarium, expansion of the ovary or mesoovariurn by inflammatory or neoplastic processes dis-
March
Fig.
6.-Bilateral
displaced enlng
CT OF TUBOOVARIAN
1992
AJR:158,
577
ABSCESS
abscesses with CT scan shows thickdIsplacement of both right and tuboovarian
mesosalpinges.
and anterior
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
left mesosalplnges.
7-Drawing of paramedian sagittal section broad ligament ft = fallopian tube, mx = mesosalplnx, o = ovary, me = mesovarlum, mm = mesometrlum. Fig.
through
Fig. 8.-CT scan shows thickening of uterosacral ligaments (arrows) in a patient with bilateral
tuboovarian abscesses. tenuation of edematous
Fig. 9.-CT
scan
Also note increased penrectal
shows
at-
fat.
normal
uterosacral
hg-
aments (arrows).
places the mesosalpinx anteriorly (Figs. 4-7). Anterior displacement of the mesosalpinx by a pelvic mass, therefore, suggests ovarian or tubal origin [4]. Anterior displacement and thickening of the ipsilateral mesosalpinx in tuboovarian abscess has been described [4]. This combination of displacement and thickening was present in all of our patients. Although
highly
suggestive
for tuboovarian
abscess
with
pelvic
Thickening
endometriosis
of Uterosacral
of adnexal
disease,
it is not specific
and may also be observed or ovarian
in patients
neoplasm.
adnexal
or tubal
Ligaments
disease
may cause
CT (Fig. 9).
Rectosigmoid
Involvement
Because the inflammation and fibrosis associated with tuboovarian abscess tend to spread posteriorly into the penrectal and presacral fat, barium enema frequently shows extrinsic rectosigmoid involvement. The mucosa appears intact, with serrated or spiculated margins. A long segment of
The uterosacral ligaments represent localized condensation of subserous endopelvic tissue. They are contiguous with the uterus and broad ligament and course posteriorly to join the deep fascia over the sacrum. Posterior extension of inflammatory
finding was present in four of our patients. The normal thickness of the uterosacral ligaments on CT scans has not been established. As with other fascial planes, the normal uterosacral ligaments are symmetrically very thin and distinct on
thickening
of the
uterosacral ligaments and increased density of the presacral and penrectal fat [4]. Uterosacral ligament thickening, in conjunction with anterior displacement of the mesosalpinx, provides additional evidence for adnexal disease (Fig. 8). This
tapered narrowing is typical. Phillips [3] found constriction of the sigmoid colon in 28 (88%) of 32 patients with tuboovarian abscess
who
had barium
enema.
On CT scans,
luminal
nar-
rowing, infiltration of perirectal fat, and indistinct borders between the pelvic mass and bowel suggest rectosigmoid involvement (Figs. 1 0 and 1 1). These findings were present in all of our patients. Fistulous communication between the tuboovarian abscess and sigmoid colon is a rare complication
[3].
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
578
WILBUR
,
--
March
1992
-
Fig. 10.-CT scan shows poorly defined fluid soft-tissue-density pelvic mass surrounding rectosigmoid area. MargIns between mass and bowel are IndIstinct Thickening of uterosacral ligament (arrows) and edema of presacral fat are also present.
and
AJR:158,
-
,,#{248}z
-.
ET AL.
Fig. I 1.-Tuboovarian abscess. CT scan shows large, thick-walled fluid collection in right side of pelvis causing extrinsic mass effect and displacemont of rectosigmoid to left. Also note left hydroureter (arrow).
Fig.
phrosis
12.-CT scan and paraaortic
shows bilateral hydronelymphadenopathy
due to
tuboovarlan abscess. (Same patient as
In Fig.
2.)
Fig. 13.-Endometriosis. CT scan shows multiloculated fluid collection near left uterine fundus simulating tuboovarlan abscess. Fluid is also prosent within cul-de-sac.
Fig. 14.-Pelvic abscess in patient with Crohn’s CT scan shows thick-walled, fluid-density mass near right adnexa. Note normal attenuation of perirectal and presacral fat No evidence of ureteral constriction or of mesosalpinx displacedisease.
mont is seen.
Ag 15.-Serous
cystadenocarcinoma.
CT scan
shows large, septated pelvic mass containing both fluid and soft-tissue-density components. Mahignant ovarian neoplasm may appear cystic and
.4:.
must be included in difterential diagnosis benign or inflammatory pelvic disease.
of cystic
Fig. 16.-Corpus luteum cyst. CT scan shows homogeneous, thin-walled, nonseptated left adnexal cystic mass. Note normal attenuation of perirectal
fat and absence
of hydroureter.
AJR:158,
March
Downloaded from www.ajronline.org by 117.253.224.13 on 10/16/15 from IP address 117.253.224.13. Copyright ARRS. For personal use only; all rights reserved
Ureteral
CT OF TUBOOVARIAN
1992
Differential
Involvement
The
pelvic
ureters
form
ovarian spasm served
fossa
and, as such,
the posterior
boundary
may be compressed
of the
or undergo
in patients with tuboovarian abscess. Phillips [3] obproximal ureteral dilatation in 17 (39%) of 44 patients with tuboovanan abscess who had excretory urography. CT may show bilateral or unilateral hydronephrosis and hydroureter (Fig. I 2). The point of ureteral obstruction is usually at or just below the pelvic brim.
579
ABSCESS
Diagnosis
The CT differential diagnosis of tuboovarian abscess includes endornetriosis, ovarian tumors and cysts, and abscesses from other sources within the pelvis and abdomen (Figs. 13-16). Imaging findings of endornetriosis in particular can mimic those of tuboovarian abscess. In the abscence of internal gas bubbles, tuboovarian abscess is radiologically indistinguishable from pelvic endometriosis.
REFERENCES
DV, Sweet AL. Current trends in the diagnosis and treatment tuboovanan abscess. Am J Obstet Gynecol 1985;1 51:1098-1101 2. Centers for Disease Control. Pelvic inflammatory disease: guidelines prevention and management. MMWR 1991;40(AR-5): 1-25 1 . Landers
Paraaortic
Lymphadenopathy
The lymphatic parallels
drainage
the gonadal
veins.
of the ovaries As a result,
and fallopian
inflammatory
tubes
paraaor-
tic lymphadenopathy occurs near the level of the renal hila (Fig. 12). This finding was present in three of our patients.
3. Phillips JC. A spectrum of radiologic abnormalities abscess. Radiology 1974;1 10:307-311 4. Wilbur A. Computed tomography of tuboovarian Assist Tomogr 1990:14:625-628
of
for
due to tubo-ovarian abscesses.
J Comput
