Sonographic cervical motion tenderness: A sign found in a patient？ 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). According to the 1991 Center for Disease Control guidelines for the prevention and management of PID, treatment should be initiated on the basis of the following minimum clinical criteria for pelvic inflammation: lower abdominal tenderness, bilateral adnexal tenderness, or cervical motion tenderness (CMT). Additional criteria for the diagnosis include oral temperature >38.3°C, elevated erythrocyte sedimentation rate and/or C-reactive protein, culture or non-culture evidence of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis, or histo-pathological evidence on endometrial biopsy and/or laparoscopy [1].Pain upon movement of the cervix with the health care provider's gloved fingers is suggestive of an inflammatory process of the pelvic organs. CMT, when present, is classically found on bimanual examination of the cervix and uterus. While CMT is often associated with pelvic inflammatory disease, it can be present in other disease entities such as ectopic pregnancy, endometriosis, ovarian torsion, appendicitis, and perforated abdominal viscus.PID is not a singular disease entity but describes a spectrum of disease. It is an upper genital tract infection, which may affect the uterus, fallopian tubes, ovaries, and peritoneum. PID can begin as cervicitis, progress to endometritis, followed by involvement of the fallopian tubes as pyosalpinx, and ultimately involve the ovary as a tubo-ovarian abscess (TOA). The two most common causative pathogens are N. gonorrhoeae and C. trachomatis although the infection is often polymicrobial [2].The American Institute of Ultrasound in Medicine practice guidelines for the performance of pelvic sonography lists pelvic pain, an abnormal or technically limited pelvic examination, or signs or symptoms of pelvic infection, each as indications for applying this modality [3].B