Sonographic cervical motion tenderness: A sign found in a patient with pelvic inflammatory disease

Abstract

No single historical, physical, laboratory, or imaging finding is both sensitive and specific for the diagnosis of pelvic inflammatory disease (PID). Cervical motion tenderness (CMT), when present, is classically found on bimanual examination of the cervix and uterus. CMT is often associated with PID but can be present in other disease entities. We present a case report of a patient who was ultimately diagnosed with acute PID. The evaluating physician performed a trans-vaginal bedside ultrasound, and the operator appreciated 'sonographic CMT'. In cases where the physical examination is equivocal or in patients where the exact location of tenderness is difficult to discern, performing a trans-vaginal bedside ultrasound examination can increase the physician's confidence that CMT is present as the cervix is being directly visualized as pressure is applied with the probe. Bedside ultrasound and specifically sonographic CMT may prove useful in diagnosing PID in patients with equivocal or unclear physical examination findings.

Figure 1

Sagittal view of the uterus on trans-vaginal ultrasound. A bulky heterogeneous anteverted uterus is seen. The striated pattern suggests inflammation and infection.

Figure 2

Coronal view of left tubo-ovarian complex. A more organized heterogeneous collection consistent with an abscess.