BACKGROUNd: Tubo-ovarian abscess is a serious complication of pelvic inflammatory disease, with a high associated morbidity. Although tubo-ovarian abscess is not a rare entity, its diagnosis presents multiple challenges. Prior literature has suggested that pelvic ultrasound is now the "gold standard" in the diagnosis of tubo-ovarian abscess. OBJECTIVE: Given the increasing use of ultrasound in the emergency department, it is important to understand the diagnostic value of transvaginal ultrasound in ruling in and ruling out important gynecologic emergencies. Our objective is to review the literature to evaluate the sensitivity and specificity of ultrasound in the diagnosis of tubo-ovarian abscess. CASE REPORT: We review a case of a 31-year-old woman with frank peritonitis caused by a tubo-ovarian abscess diagnosed by contrast-enhanced computed tomography after an initial negative transvaginal ultrasound. CONCLUSION: We found evidence for lower sensitivity and specificity of ultrasound for the diagnosis of tubo-ovarian abscess than generally reported in the emergency medicine literature.
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