Pyometra | Uterus

Laura Miller MD Ashley Davidoff MD

Definition

Pyometra is collection of pus in uterine cavity caused by an infection of the uterine cavity most often as a result of a uterine obstruction.

The result is pus filled endometrial; cavity.

The structural changes vary, but are usually characterized by obstruction of the connection between the uterus and the lower reproductive tract.

The functional changes are characterized by accumulation of blood or tissue in the uterine cavity, followed by infection of the endometrium and uterine contents.

Women may present clinically with bloody or purulent vaginal discharge and uterine enlargement. Women present less commonly with signs of systemic infection, including fever. In the postmenopausal woman underlying malignancy must be excluded.

Diagnosis is made based on clinical history, physical exam findings and imaging with ultrasound.

Treatment involves relief of the obstruction and may require antibiotic therapy.

Endometrial Carcinoma

The axial CTscan is from a 31 year old female with carcinoma. The images show an expanded irregular endometrial cavity (yellow) that contains air (black), soft tissue (green), and fluid (yellow), uterus with an enhancing filling defect (green overlay in b). The mass could arise from the cervix based on its position or from the uterus. The former is more likely based on the patients age..

A solid appearing mass is seen in the right adnexa (dark green) representing either a solid mass in the ovary or a enlarged iliac node.

These findings are consistent cervical carcinoma or less likely endometrial with secondary obstruction and pyometria.

Obstruction and Infection

The axial CTscan is from a 46 year old female with cervical carcinoma. The images show an expanded irregular endometrial cavity (yellow) that contains air (black), thickened irregular cervix (soft tissue green), and fluid (yellow).

These findings are consistent cervical carcinoma or less likely endometrial with secondary obstruction and pyometria.

Obstructed Uterus with Pyometria

46 year old female with obstructed uterus and fluid filled endometrial cavity with pockets of air caused by cervical carcinoma complicated by pyometria.