ABSTRACT
OBJECTIVE: The purpose of this study was to identify retrospectively the different computed tomography markers and sonography in a series of surgically and pathologically proven cases of tubo-ovarian abscesses in order to achieve correct preoperative diagnosis of this life-threatening condition. METHODS: A review of the medical and pathological records from the department of obstetrics and gynecology, Catholic University Medical College from January 1993 to January 2003 confirmed 79 patients with the diagnosis of tubo-ovarian abscess. Patient were divided into two groups. From this group 15 patients who underwent CT prior to therapy were identified, and the medical records, pathologic reports and CT of these patients were retrospectively reviewed and correlated. RESULTS: All 79 patients underwent operative surgery and were confirmed tubo-ovarian abscess. CT findings of tubo-ovarian abscess present in our patients were (a) a thick-walled fluid-density mass in an adnexal location, (b) septation or partial septation within the mass, (c) indistinct borders with the uterus and adjacent bowel loops, (d) anterior displacement of the mesosalpinx, indicating a probable adnexal origin, and (e) bilateral or unilateral hydronephrosis with hydroureter. CONCLUSION: Tubo-ovarian abscess must be considered in the differential diagnosis of cystic unilateral or bilateral pelvic masses identified on CT. CT usually plays a secondary role in the diagnosis of tubo-ovarian abscess but can be valuable in difficult cases. Lack of a typical clinical presentation should not dissuade the radiologist from suggesting this diagnosis; indeed, the atypical presentation may be the reason why the patient is being evaluated initially with CT rather than with ultrasound.