Computed Tomography Features of Pelvic Inflammatory Disease Caused by Chlamydia trachomatis and Neisseria gonorrhoeae

ABSTRACT Objective To characterize computed tomography (CT) findings in women with pelvic inflammatory disease (PID) due to PCR-confirmed Chlamydia trachomatis or Neisseria gonorrhoeae , and to identify imaging patterns that may assist diagnosis in the emergency setting. Methods We conducted a retrospective study of 44 female patients who underwent abdominal or pelvic CT in the gynecology emergency department and tested positive for C.trachomatis, N. gonorrhoeae , or both. CT images were re-evaluated by two radiologists for signs consistent with PID. Imaging findings were compared across three analyses: (1) cases correctly vs. incorrectly diagnosed in the original radiology report, (2) concordant vs. discordant interpretations between original and retrospective reads, and (3) differences between infections caused by C.trachomatis and N.gonorrhoeae. Results CT features consistent with PID were present in 77.3% of cases. The most frequent findings were fat stranding (86.4%), free pelvic fluid (79.5%), and peritoneal thickening (72.7%). Tubo-ovarian abscesses (TOAs) occurred in 36.4% and were always correctly identified. Subtle peritoneal thickening was more frequent in discordant interpretations (100% vs 63%, p = 0.01). Fallopian-tube thickening was more common in C. trachomatis than N. gonorrhoeae infection (49% vs 11%, p = 0.013). Conclusion CT often reveals characteristic features of PID even when the condition is not clinically suspected. Subtle radiologic findings—particularly peritoneal thickening or enhancement and pelvic fat stranding— are often overlooked during emergency evaluation. Increased awareness of these signs may facilitate earlier recognition and management.