Sonographic cervical motion tenderness: A sign found in a patientÂ with pelvic inflammatory disease
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.
- Aral SO, Brunham RC, Cates W, Eschenbach DA, Farmer MY, Faro S, Gale JL, Grimes DA, Holmes KK, Marchbanks PA, McGee ZA, Nixon SA, Wiesner PJ, Pasley JN, Patton DS, Peterson HB, Rice PA, Rolfs RT, Sayers D, Schacter J, Soper D, Sweet RL, Washington AE, Wasserheit JN, Westrom L, Witkin S: Pelvic inflammatory disease: guidelines for prevention and management. MMWR 40(RR-5). 1991, 1–25.
- Holland-Hall C: Sexually transmitted infections: screening, syndromes, and symptoms. Prim Care 2006,33(2):433–454. CrossRef
- American Institute of Ultrasound in Medicine: AIUM practice guideline for the performance of pelvic ultrasound examinations. J Ultrasound Med 2010,29(1):166–172.
- Boardman LA, Peipert JF, Brody JM, Cooper AS, Sung J: Endovaginal sonography for the diagnosis of upper genital tract infection. Obstet Gynecol 1997,90(1):54–57. CrossRef
- Tayal VS, Bullard M, Swanson DR, Schulz CJ, Bacalis KN, Bliss SA, Norton HJ: ED endovaginal pelvic ultrasound in nonpregnant women with right lower quadrant pain. Am J Emerg Med 2008,26(1):81–85. CrossRef
- Tayal VS, Crean CA, Norton HJ, Schulz CJ, Bacalis KN, Bliss S: Prospective comparative trial of endovaginal sonographic bimanual examination versus traditional digital bimanual examination in nonpregnant women with lower abdominal pain with regard to body mass index classification. J Ultrasound Med 2008,27(8):1171–1177.
- Adhikari S, Blaivas M, Lyon M: Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. J Emerg Med 2008,34(4):429–433. CrossRef
- Zeger W, Holt K: Gynecologic infections. Emerg Med Clin N Am 2003,21(3):631–648. CrossRef
- Lambert MJ, Villa M: Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am 2004,22(3):683–696. CrossRef
- Webb EM, Green GE, Scoutt LM: Adnexal mass with pelvic pain. Radiol Clin North Am 2004,42(2):329–348. CrossRef
- Sonographic cervical motion tenderness: A sign found in a patientÂ with pelvic inflammatory disease
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Critical Ultrasound Journal
- Online Date
- September 2012
- Print ISSN
- Online ISSN
- Springer Milan
- Additional Links
- Pelvic inflammatory disease
- Cervical motion tenderness
- Sonographic CMT
- Bedside ultrasound
- Author Affiliations
- 1. Department of Emergency Medicine, St. Luke’s/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY, 10025, USA
- 2. Department of Emergency Medicine, Yale-New Haven Hospital, 464 Congress Avenue, Suite 260, New Haven, CT, 06519, USA