Which of the following best describes the role of ultrasound in suspected PID cases?
a. Ultrasound cannot rule out PID, but there are some ultrasound findings that are considered specific for PID.
b. All patients with suspected PID should have emergent ultrasound performed in order to rule out complications.
c. Tubo-ovarian abscess is a common ultrasound finding in PID; it can be treated in the outpatient setting with no alteration to the standard treatment regimen.
d. When combined with negative gonorrhea and chlamydia testing, a negative pelvic ultrasound effectively rules out PID.
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Answer: A. While useful in cases where PID complications are being considered, an ultrasound is not mandatory in all cases of suspected uncomplicated PID. Patients with tubo-ovarian abscess require more aggressive therapy and should be transferred to the ED or inpatient setting. Abdominopelvic ultrasound does not carry the sensitivity to exclude PID, and negative results should not dissuade clinicians from treating PID empirically.
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