OP19.05: Ultrasound for discrimination between acute salpingitis and other conditions in patients with clinical signs and symptoms suggesting acute salpingits: a prospective observational cross sectional study

Abstract

Objectives: To describe ultrasound findings in patients with acute salpingitis and to determine if it is possible using ultrasound to discriminate between acute salpingitis and other painful conditions mimicking clinical symptoms/ findings of acute salpingitis. Methods: 52 patients underwent a standardized transvaginal ultrasound scan before diagnostic laparoscopy because of clinical suspicion of acute salpingitis. The laparoscopist was blinded to scan results. Final diagnosis was based on laparoscopy, histology of the endometrium or other histology where relevant. Results: 29 patients had a final diagnosis of cervicitis (n = 3), endometritis (n = 9), or salpingitis (n = 17), 23 (44%) had a diagnosis unrelated to genital infection. In 4 cases the salpingitis was mild, in 8 moderate, in 5 severe (pyosalpinx). Bilateral adnexal masses and bilateral masses lying adjacent to the ovary were seen more often at scan in patients with salpingitis than with other diagnoses (14/17 vs. 6/35, P = 0.000; 11/17 vs. 6/35, P = 0.001). In salpingitis, the masses lying adjacent to the ovaries were on average 2–3 cm in diameter, solid (n = 14), unilocular (n = 4) or multilocular (n = 3) cystic, or multilocular solid (n = 1), and well vascularized at color Doppler. Spectral Doppler results overlapped between patients with different diagnoses. The sensitivity with regard to acute salpingitis of subjective assessment of scan findings by the sonologist was 82%, specificity 77%, positive and negative likelihood ratio (LR+) 3.6 and 0.23. Those of scan findings of bilateral masses lying adjacent to the ovary were 65%, 83%, LR+ 3.8 and LR− 0.42. The corresponding figures for bilateral adnexal masses were 82%, 83%, 4.8 and 0.22. Conclusions: In patients with clinical suspicion of acute salpingitis, absence of bilateral adnexal masses at scan decreases the odds of acute salpingitis 5-fold.