Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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Fluid-filled, distended fallopian tube


A hydrosalpinx is a dilated fallopian tube filled with fluid. A normal tube is not visible sonographically; however, when a tube becomes obstructed, it distends and fills with fluid, giving it a sausage-like appearance. Infection is a major cause of hydrosalpinx, also called pelvic inflammatory disease (PID), in which the tube fills with pus in the acute phase of the disease (pyosalpinx). In ectopic pregnancy, the tube can distend and fill with blood (hematosalpinx) and have a similar appearance to a pyosalpinx. Tubal torsion presents with acute pain and a tender, distended tube. Scarring and adhesions in the pelvis can obstruct the tubes and allow them to fill with fluid, but this is more often found in asymptomatic patients since it is not an acute process. This can also be seen in cases of severe endometriosis, or previous pelvic surgery. Rarely, tuberculosis and other infections can attack the pelvis and result in hydrosalpinx.

Ultrasound Findings

A hydrosalpinx has a typical sonographic appearance. Evaluation of the adnexa reveals a cystic, sausage-shaped, serpiginous, tubular mass. The distended tube often has a characteristic “spoke-wheel” pattern made up by the incomplete septae of the tube. The tube can become redundant and fold upon itself, giving the appearance of a multiseptate cystic mass. If the adjacent ovary is not clearly visualized, it is easy to suspect ovarian pathology. If the hydrosalpinx is the result of pelvic inflammatory disease, the tubal wall can occasionally be thick and irregular, making the correct diagnosis more difficult. In the study by Sokalska and colleagues (from the IOTA multicenter study), the sensitivity for the sonographic diagnosis of hydrosalpinx was 86%.
Hydrosalpinges are often accompanied by free pelvic fluid, especially in acute pelvic inflammatory disease or ectopic pregnancy. The presence of a solid mass within a dilated tube, along with a negative pregnancy test, may suggest fallopian tube carcinoma, although abundant vascularity would also usually be present.
Three-dimensional ultrasound is very helpful for demonstrating the course of the dilated tubes. Once a volume is obtained, the complete cast of the convoluted fallopian tube is easily seen using the inverse mode. This technique enables the practitioner to view a cast of the entire cystic tube previously hidden within the volume. The whole tube is then demonstrated, even if the tube traverses multiple planes.

Differential Diagnosis

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