Reactive uterine enlargement associated with PID

📄 SCRS

Bulky uterus
or
Reactive PID

Bulky uterus or Reactive PID ultrasound case study

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Reporting Panel

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Uterine Pathology

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USG

Bulky uterus or Reactive PID ultrasound case study

CASE–1

Clinical History

A 34-year-old female presented with lower abdominal pain, fever, abnormal vaginal discharge, and pelvic tenderness. She was referred for pelvic ultrasound to evaluate suspected pelvic inflammatory disease (PID). There was no history suggestive of uterine fibroids or adenomyosis.

Ultrasound Findings

Ultrasound examination demonstrates a mildly bulky anteverted uterus measuring approximately 12.7 × 5.9 × 5.0 cm (estimated uterine volume 197 mL). The myometrium appears mildly heterogeneous without any focal myometrial mass or fibroid. The endometrial thickness measures approximately 9.5 mm and appears regular. Mild diffuse reactive enlargement of the uterus is noted. Mild inflammatory changes are present within the pelvis, with a small amount of free fluid in the pouch of Douglas. No retained products of conception or intrauterine collection is identified. Both ovaries are visualized with preserved morphology and vascularity.

Transabdominal pelvic ultrasound. Mildly enlarged (bulky) uterus measuring approximately 12.7 × 5.9 × 5.0 cm with mildly heterogeneous myometrium. Endometrial thickness measures 9.5 mm. The findings are compatible with reactive uterine enlargement associated with pelvic inflammatory disease (PID).

Report Line

Mild bulky uterus measuring approximately 12.7 × 5.9 × 5.0 cm (estimated uterine volume 197 mL) with mildly heterogeneous myometrial echotexture. Endometrial thickness measures 9.5 mm. No focal myometrial lesion is identified. Mild reactive inflammatory enlargement of the uterus is noted in association with pelvic inflammatory changes, consistent with PID-associated bulky uterus.

Impression

Reactive uterine enlargement associated with pelvic inflammatory disease (PID).

Recommendation

Clinical correlation with symptoms, pelvic examination, and inflammatory markers is recommended. Appropriate antibiotic therapy should be considered according to institutional PID guidelines. Follow-up pelvic ultrasound after completion of treatment may be performed to document resolution of the reactive uterine enlargement and associated inflammatory changes.

Key Learning Points

• A mildly bulky uterus is a non-specific ultrasound finding and may occur as a reactive change in PID.
• Reactive uterine enlargement is characterized by diffuse mild uterine enlargement without a focal myometrial mass.
• The myometrium may appear mildly heterogeneous due to inflammatory edema.
• The endometrium may be normal or mildly thickened depending on associated endometritis.
• Associated ultrasound findings of PID include pelvic free fluid, salpingitis, hydrosalpinx, pyosalpinx, tubo-ovarian complex, or tubo-ovarian abscess.
• Color Doppler may demonstrate increased myometrial vascularity in active inflammation.
• Correlation with clinical findings and laboratory investigations is essential, as ultrasound findings alone are not diagnostic of PID.