BACKGROUND: Timely diagnosis of pelvic inflammatory disease (PID) is essential for effective management, as delayed treatment can lead to serious complications, including infertility and chronic pelvic pain. Acute PID often presents with mild, varied symptoms, making diagnosis challenging and risking delayed intervention. While laparoscopy provides high diagnostic accuracy for PID, its limited availability and occasional inability to detect subtle cases restrict its utility in routine clinical settings. AIM: This article aims to assess the diagnostic role of transvaginal sonography (TVS) as an accessible, nonionizing alternative for early PID detection, with a focus on its use alongside clinical evaluation to enhance diagnostic accuracy. METHODS: This article synthesizes recent studies on the diagnostic efficacy of TVS for acute PID. Relevant literature was selected to evaluate TVS's sensitivity, specificity, and clinical utility in detecting pelvic inflammatory changes, comparing it to laparoscopy as the reference standard. RESULTS: The findings suggest that TVS, particularly when combined with thorough clinical assessment, offers high sensitivity and specificity in identifying inflammatory changes associated with PID. TVS enables timely diagnosis, facilitating earlier treatment and reducing upper genital tract complications. Moreover, its noninvasive nature and accessibility make it a practical alternative to laparoscopy in diverse healthcare settings. CONCLUSION: TVS serves as a valuable diagnostic tool for early PID detection, especially when laparoscopy is unavailable. Its integration with clinical evaluation can expedite diagnosis, improve patient outcomes, and mitigate the risk of severe reproductive complications, supporting TVS as a critical component in PID management protocols.