図７の１〜図３の５までの嚢胞性病変は子宮に接し，楕円形で，壁がよく造影されている．図４の６〜図８の１１は円形嚢胞性病変と連続性の管状構造の病変で，図８の１１で子宮近辺で盲端になるので円形病変が卵巣で管状病変が卵管と解釈する．単なる嚢胞性疾患にしては全体的に壁が厚く，壁の造影効果が強く感染性の病変を示唆する．図５の３の嚢胞壁には乳頭状の隆起性病変を伴う（↑）が，どの臓器の嚢胞でも同様に，腫瘍性嚢胞を疑うべきである．　図６の△はKerckring襞を有し，緊満感があって襞のない卵管とは異なり小腸である．虫垂炎穿孔による膿瘍と診断し手術となったが，右卵管卵巣膿瘍（tubo-ovarian　abscess）であった．図５の乳頭状隆起病変（↑）はserous papillary adenocarcinomaと診断された．

参考文献：tubo-ovarian abscess
１）Radiographics. 2002 Nov-Dec;22(6):1327-34.
Spectrum of CT findings in acute pyogenic pelvic inflammatory disease.
Sam JW, Jacobs JE, Birnbaum BA.

Pelvic inflammatory disease (PID) is a common medical problem, affecting nearly 1 million women each year. Although the radiology literature is replete with discussions of the sonographic manifestations of PID, little has been published regarding the computed tomographic (CT) appearances of this entity. CT findings in early PID include obscuration of the normal pelvic floor fascial planes, thickening of the uterosacral ligaments, cervicitis, oophoritis, salpingitis, and accumulation of simple fluid in the endometrial canal, fallopian tubes, and pelvis. As the disease progresses, this simple fluid may become complex and the inflammatory changes may progress to frank tubo-ovarian or pelvic abscesses. Reactive inflammation of adjacent structures is common and can manifest as small or large bowel ileus or obstruction, hydroureter and hydronephrosis, right upper quadrant inflammation (Fitz-Hugh-Curtis syndrome), or peritonitis. Familiarity with the CT appearances of these manifestations is important for timely diagnosis and treatment of PID and its complications.PMID: 12432105（full text）

２）J Am Coll Surg. 1999 May;188(5):567-72.
Trends in the management of pelvic abscesses.
Mirhashemi R, Schoell WM, Estape R, Angioli R, Averette HE.

conclusions：Tubo-ovarian abscess(tob) is a serious consequence of PID. Early diagnosis and treatment are of utmost importance for the prevention of sequela including infertility, ectopic pregnancy, and chronic pelvic pain. Medical treatment with broad-spectrum antibiotics has allowed patients to avoid operations. Even though conservative treatment is frequently successful, 25% of these patients will require surgical intervention. Percutaneous drainage and operative drainage are becoming popular for tobs, but more prospective randomized studies are required to dtermine efficacy(fig.1). PMID: 10235587