Pelvic inflammatory disease (PID) refers to inflammation involving the uterus and adnexa, and occurs in 10% of reproductive-age women. PID usually results from an ascending vaginal or cervical infection progressing to endometritis and salpingitis. Usually PID resolves with conservative therapy and may have sequelae of tubo-ovarian adhesions or hydrosalpinx. However, it can lead to infertility, ectopic pregnancy, and chronic pelvic pain, and it may progress to tubo-ovarian abscess (TOA), in which there is destruction of adnexal structures. Radiological findings vary with the severity of disease from normal to a multilocular, thick-walled, fluid-density mass of TOA. Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying PID. Radiologic features are loculated fluid collection at the perihepatic region and linear subcapsular enhancement of the liver and spleen. Actinomycosis, tuberculosis, and xanthogranulomatous inflammation are rare causes of TOA. They are frequently misdiagnosed as malignant ovarian tumors due to CT and MR imaging appearances unusual for TOAs. Tumefactive and infiltrative solid or solid and cystic lesion with invading adjacent normal anatomic barriers or structures is a characteristic imaging finding of actinomycosis. These findings with the presence of an intrauterine device provide a diagnostic clue. Pelvic tuberculous usually mimic peritoneal carcinomatosis from ovarian cancers. The common radiological features are adnexal masses, ascites, and smooth omental and peritoneal thickening. The imaging findings of xanthogranulomatous inflammation of salpinges or ovaries are rarely been described and are usually nonspecific.