Endometritis





KEY FACTS


Terminology





  • Polymicrobial infection resulting from ascending spread of organisms from cervix or from incision into uterus



Imaging





  • Endometritis is predominantly a clinical diagnosis: Postpartum fever and pelvic pain



  • Imaging usually ordered to look for complications: Pyometrium, abscess, retained products of conception



  • Endometrium may appear normal or be thick and heterogeneous



  • Endometrial gas, fluid and inflammatory debris; gas bubbles alone are not diagnostic as gas is normal finding for up to 3 weeks postpartum, present in up to 21% of healthy patients



  • Hyperechoic foci within endometrial cavity ± shadowing



  • Large amount of echogenic fluid suspicious for pyometra



  • May see increased flow on color Doppler




    • Lack of ↑ flow does not rule out endometritis




  • Fluid in cul-de-sac



Top Differential Diagnoses





  • Retained products of conception



  • Intrauterine blood/clot



  • Asymptomatic postpartum endometrial gas



  • Endometrial calcifications



Clinical Issues





  • Most common cause of postpartum fever, 1-3% of vaginal deliveries, more common following cesarean section



  • Occasionally associated with pelvic inflammatory disease or intrauterine device in nonobstetric patient



  • Rarely leads to development of pelvic septic thrombophlebitis



Diagnostic Checklist





  • Endometritis is predominantly clinical diagnosis



  • In appropriate clinical setting (postpartum fever and pain), presence of endometrial fluid and bubbles is highly suggestive of endometritis



Scanning Tips





  • Evaluate for color flow in endometrial debris, noting that gas bubbles may produce artifactual signal; confirm with spectral Doppler







Graphic shows findings in endometritis, including hyperemia of the endometrium , with associated fluid and gas bubbles in the endometrial cavity.








Longitudinal transvaginal ultrasound shows nonspecific endometrial thickening and echogenic endometrial fluid in this patient with pelvic inflammatory disease, diagnosed by vaginal discharge and pelvic pain.








Longitudinal transvaginal ultrasound in a patient with fever and pain from endometritis is shown. The endometrium is indistinct and there are multiple punctate and linear echogenicities at the interface of the myometrium and endometrium.








Longitudinal transvaginal ultrasound performed for fever 6 weeks after cesarean section shows trace fluid in the endometrial cavity with nonspecific endometrial thickening . There is no fluid in the cesarean section scar .








Longitudinal transvaginal ultrasound performed for pain and fever after cesarean section shows fluid and gas in the cesarean section scar . No fluid was seen in the endometrial cavity .





Nov 10, 2024 | Posted by in ULTRASONOGRAPHY | Comments Off on Endometritis

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