SHM Converge Scientific Abstract ePoster Gallery-A Uterus Under Pressure: A Rare Case of Pyometra

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This case describes a 57-year-old woman with resistant hypertension and end-stage renal disease on hemodialysis who presented with five days of fever, chills, and suprapubic pain. Initial labs showed leukocytosis and anemia. CT imaging was first interpreted as emphysematous cystitis because it appeared to show a distended urinary bladder with mural thickening and gas. However, this diagnosis did not fit the clinical picture, since the patient had been anuric for years and urine could not be obtained.<br /><br />A repeat MRI clarified the finding: the “bladder” was actually a markedly distended uterus containing fluid and gas, concerning for endometritis or pyometra, with an atrophic bladder nearby. The patient was treated empirically with piperacillin-tazobactam, but pain persisted. Intrauterine fluid cultures grew E. coli, supporting the diagnosis of pyometra. She ultimately required exploratory laparotomy with hysterectomy and bilateral salpingo-oophorectomy.<br /><br />The report emphasizes that pyometra is rare, often nonspecific in presentation, and frequently misdiagnosed, especially in postmenopausal women. Ultrasound is typically the preferred initial study, but CT or MRI may be needed to assess for complications such as perforation. Stable patients may respond to antibiotics, but failure to improve should prompt urgent gynecologic intervention, including drainage or surgery. Follow-up and histologic evaluation are important because cervical stenosis or malignancy may underlie the condition.<br /><br />Key lesson: clinicians should personally review imaging and interpret it in the context of the patient’s history and symptoms. Pyometra should remain on the differential diagnosis for postmenopausal patients with unexplained abdominal or pelvic pain.

Asset Subtitle

Erika M. Nguyen

Meta Tag

Author List Ashley M. Perry, Erika M. Nguyen

Category Clinical Vignettes

Concept Pyometra

Concept Postmenopausal patient

Concept Emphysematous cystitis

Concept Bladder Distension

Concept Ultrasound

Distinguished Non-Finalist

Presenter Organization University of South Florida Morsani College of Medicine

Presenting Author Erika M. Nguyen

Track Adult

Keywords

pyometra

endometritis

postmenopausal woman

resistant hypertension

end-stage renal disease

hemodialysis

abdominal pain

pelvic imaging

E. coli infection

hysterectomy

Pyometra

Postmenopausal patient

Emphysematous cystitis

Bladder Distension

Ultrasound