Preliminary Diagnosis: Endometritis

I. What imaging technique is first-line for this diagnosis

  • Ultrasound of the pelvis; transvaginal imaging offers better evaluation compared to a transabdominal approach.

II. Describe the advantages and disadvantages of this technique for diagnosis of endometritis.

Advantages
  • Highly portable imaging modality that does not expose patients to ionizing radiation

  • Offers exquisite visualization of the surrounding vasculature

Disadvantages
  • Limited in sensitivity and specificity in evaluating the surrounding soft tissues and osseous structures

  • Limited in giving a detailed evaluation of the surrounding soft tissues

  • Limited in characterizing any secondary complications

  • Highly operator dependent

  • Endometritis is more of a clinical diagnosis

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to sonographic imaging exist

IV. What alternative imaging techniques are available?

  • MRI

  • CT imaging of the pelvis with and without contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of endometritis.

MRI
Advantages
  • Does not expose patients to ionizing radiation

  • Offers great sensitivity and specificity in evaluating the soft tissues and layers of the uterus and is able to detect any secondary complications.

Disadvantages
  • Expensive

  • Time-consuming

  • May be subject to motion and susceptibility weighted artifact

  • Endometritis is more of a clinical diagnosis

CT Imaging of the pelvis with and without contrast
Advantages
  • Offers exquisite detail of the surrounding soft tissues and osseous structures

  • May help guide treatment, therapy, and biopsy

  • Relatively quick imaging modality compared to MR imaging

Disadvantages
  • Exposes patients to ionizing radiation

  • Offers less detailed evaluation of the surrounding soft tissues and the soft tissues of the uterus

VI. What are the contraindications for the alternative imaging techniques?

MRI
  • Contraindicated in patients with non-MR compatible hardware

CT Imaging of the pelvis with and without contrast
  • May be contraindicated in patients who are pregnant

  • Relative contraindication to intravenous contrast use in patients with renal failure or contrast allergy