Acute Pelvic Inflaatory Diseases-The sonological features?

Acute PID : What are the sonological characteristics?? What are the soologicalsigns of acute endometritis??

 Ans: Besides ,   1) free fluid  ,2)  hydrosalpinx 3)  oophoritis. 4)  There may be  thickened irregular endometrial myometrial   junction which  can be used a strong supportive sign for inflammatory reaction. 5)  Thickened endometrium alone however can’t be used as the diagnostic criteria  for acute inflammation more so in such increased thickness is observed in  preovulatory  and secretory  phases which is normally present. Acute endometritis cause   to 6) edema à edema includes   the endometrium and also the subendometrial tissue due to  its close anatomical vicinity  and 7)  hyperemia due to neoangiogenesis..Dilated blood vessels are seen in  subendometrial layer to because in this layer harbour   the dilated   spiral vessels (  the main feeding  vessels of the endometrial   vessels 7 endometrial tissues 8) Endometrial oedema:- Extravasations   of the fluid   from these    dilated vessels   may also be   the cause  of edema in the subendometrial layer. 9) Why irregular endo-myometrial zone like adenomyosis?? Ans:-

Moderate oedema leads to irregularly increased thickness  of the endometrial myometrial   junctional zone . Endometrial   edema  may appear as increased   thickness of  the endometrium with a homogeneous texture. It  may have a ground galss like  echogenicity and both because of the echogenicity  similar  to that   of the normal  myometrium and also because of irregularity of the JZ  and may be   difficult   to distinguish from the  myometrium. There   may eb fluid in the endometrial cavity that is turbid.

 How helpful is USG in diagnosisg acute PID/ endometritis?? What about Doppler findings on acute endometritis?  A) Low resistance   blood flow, which signifies neoangiogensis(new blood vessels formation)  in the endometrium is common in early secretary phase . This  is so because for last 3 decades  WE KNOW THAT that normally during the preovulatory   and secretory phase   - there   is physiological   neo angiogenesis   in the endometrium:-.  .  In acute PID , too there is new blood vessels formation. Therefore this process of neoangiogensis as identified by Doppler cannot always be used  as diagnostic criteria  for diagnosis of acute inflammatory    process. Therefore    this sign   can be used    only in a phase  of the cycle   when normally the endometrium  is avascular or has  high resistance blood flow. This   phase is early proliferative   phase.  Doppler must be used   for    assessment   of the vascularity. The neoangiogenesis of inflammation is documented on ultrasound as 1)  increased vascularity in the endometrium in which vessels are  typically have larger  diameter  than the normal   spiral vessels and 2)  low resistance blood   flow. 3) Besides, the vascular distribution may be heterogeneous    due to  nonuniform involvement of the endometrium   in the  inflammatory process.  B) How to measure blood flow in endometrium?? Ans:-The 3D ultrasound is useful for assessment of the  coronal plane   and is a modality  with proved  ability  for assessment  of the endometrial  myometrial  junction. C) How to measure ET?? Tips:-endometrial   thickness is measured from outer   margin of the hyperechoic line to the outer margin  of the hyperechoic line at the  broadest part of the   endometrium perpendicular   to the central line of  the endometrium.

How many members are performing transrectal scan which  according to few sonologist is preferred  to  transabdominal route USG of endometrium??  :-The endometrium is thin and at times ill defined   and may also at times contain fluid  in the cavity.  Endometrium is best evaluated by transvaginal scan but a prior   abdominal scan is recommended for evaluation of the pelvic  anatomy.  In cases   when transvaginal scan is not possible or denied by the patient transrectal scan is preferred  to  transabdominal route.