A 16-year-old girl presents with lower abdominal pain and fever. On physical examination, a tender adnexal mass is felt. Further questioning in private reveals the following: she has a new sexual partner; her periods are irregular; she has a vaginal discharge. Which of the following test results is most likely to be seen in this scenario?
Pelvic inflammatory disease (PID) refers to sexually transmitted infections of the female upper genital tract including tubo-ovarian abscess, endometritis, salpingitis, and pelvic peritonitis. Each year, a diagnosis of PID is made in more than 1 million women. Sexually active teenagers are at great risk of acquiring PID because of their high-risk behavior, exposure to multiple partners, and failure to use contraceptives. The strong likelihood of PID in the patient presented should not preclude consideration of serious conditions requiring surgical intervention, such as appendiceal abscess, ectopic pregnancy, and ovarian cyst. Renal cyst does not present in the manner described. An episode of PID raises the risk of ectopic pregnancy, and about 20% of women become infertile following one episode of PID. Other sequelae include dyspareunia, pyosalpinx, tuboovarian abscess, and pelvic adhesions. Endometriosis is not related to PID.
Appendiceal fecalith on plain radiograph of abdomen.
Thickened and fluid-filled fallopian tubes with free pelvic fluid on ultrasound
Four-centimeter fluid filled mass arising from the left ovary
Multicystic lesions throughout the right kidney
Adolescence