Endometritis

Radiopaedia • CC-by-nc-sa 3.0 • de

Endometritis refers to inflammation or infection involving the endometrium. Endometritis can be acute or chronic and may arise in an obstetric setting, such as following delivery or miscarriage, or in a non-obstetric setting due to pelvic inflammatory disease (PID) or endometrial instrumentation.

Epidemiology

It complicates 2-3% of vaginal deliveries as well as up to 27% of Cesarean sections .

Endometritis is the most common cause of fever in a postpartum patient .

Clinical presentation

The typical presentation is with fever and lower abdominal pain. While imaging features can be helpful, the diagnosis is clinical as imaging can be normal, particularly in uncomplicated cases.

Pathology

Associations

Recognized associations include :

Radiographic features

Endometritis is a clinical diagnosis and caution should be taken due to the overlap of expected postpartum imaging findings and the ones related to the inflammatory process.

Ultrasound

While the sonographic appearance of the uterus and endometrium may be normal in early stages, findings may include:

thickened and heterogeneous endometrium
intracavitary/cul-de-sac fluid
increased vascularity on Doppler ultrasound
intrauterine air

MRI

T2: the uterus may be enlarged with overall high signal intensity
T1 C+ (Gd): can show intense enhancement of the uterus

Treatment and prognosis

Complications

progression to a pyometrium
pelvic septic thrombophlebitis

Differential diagnosis

Differential considerations include:

retained products of conception: echogenic material in the endometrial cavity showing intrinsic vascularity
endometrial carcinoma: can have overlapping sonographic features but will occur in a different clinical context
intrauterine blood clot
- no associated vascularity