Inflammation Case Studies


CASE 1: Tubo-ovarian abscess


Clinical History:

A 19-year-old woman presented to the emergency room with severe left lower quadrant abdominal pain. She had vital signs with T 39.0 C (102.2 F), P 87, R 17, and BP 100/70 mm Hg. Physical examination revealed extreme tenderness in the left lower quadrant. Her WBC count showed a leukocytosis (19,200) with a "left shift" (75% segs and 10% bands). She was taken to surgery and a laparotomy revealed that the left fallopian tube and ovary were adherent and dilated and filled with yellow purulent material that was spilling into the peritoneal cavity from a site of rupture. Culture of this material grew Neisseria gonorrheae. (images 1.1 through 1.3 are the microscopic appearance of the tube, and image 1.4 is the gross appearance).
  1. Grossly the tube and ovary are adherent. What is demonstrated on sectioning?

    2. The lumen is dilated and filled with purlent exudate.

  2. A microscopic cross section shows fallopian tube with a thickened wall and dilated lumen.

    3. What is the predominant inflammatory cell type seen in the wall and filling the lumen of the tube? These cells are neutrophils (PMN's, polys). They are forming a purulent exudate. The localized collection of pus is an abscess.

  3. What has happened to the vascular structures (blood vessels, lymphatics) in the tube?

    4. They are dilated. The blood vessels are congested (filled with blood). Lymphatics are not normally seen unless there is inflammation or obstruction.

  4. What is the process that is leading to the appearance of pink, homogenous material separating tissue structures and layered on the serosa?

    5. The inflammation has led to exudation. The pink material is fibrin. Thus, there is a fibrinous exudate.

  5. What is the diagnosis?

    6. Acute salpingitis with tubo-ovarian abscess. N. gonorrheae can lead to chronic inflammation of the tube with scarring, upon which an acute process can be superimposed.