Diagnostic Ultrasound - Abdomen and Pelvis

Hydrosalpinx
Diagnoses: Female Pelvis
TERMINOLOGY
• Fluid-filled dilatation of fallopian tubes resulting from tubal
obstruction
• Must be distinguished from pyosalpinx or hematosalpinx
based on tubal content and clinical picture
IMAGING
• Dilated tubular or oval structure separate from uterus and
ovaries
• Cystic pelvic mass or complex fluid collection
• Convoluted or S-shaped, containing incomplete septa
• Waist sign: Indentation of opposing walls of dilated tubal
structure resulting in appearance of a waist
• "Beads on a string" sign: Small hyperechoic mural nodules
on transverse imaging
• "Cogwheel" sign: Thicker endosalpingeal folds in acute PID
TOP DIFFERENTIAL DIAGNOSES
• Pyosalpinx (acute PID)
KEY FACTS
• Tubo-ovarian complex
• Cystic ovarian neoplasm
• Paraovarian cyst
• Peritoneal inclusion cyst
• Dilated bowel
PATHOLOGY
• Tube obstruction from PID
• Also associated with endometriosis, appendicitis, or post
pelvic surgery
CLINICAL ISSUES
• Usually asymptomatic
• Can present with pelvic or lower abdominal pain
• Can result in infertility
(Left) Graphic shows bilateral
hydrosalpinx. The left tube
folds upon itself st, which
appears as an incomplete
septum on ultrasound.
Adhesions and
hydrosalpinx are sequelae of
PID. (Right) Coronal
transvaginal ultrasound shows
a normal ovary ſt with a
dilated fallopian tube st. The
septa are the walls of the
folded tube.
(Left) Transabdominal
longitudinal ultrasound shows
a markedly dilated, thinwalled
hydrosalpinx with a
thin incomplete septum ſt.
(Right) Transverse
transabdominal ultrasound of
the same patient
demonstrates the more
dilated distal end of the tube
st. The uterus was normal.
The incomplete septum ſt is
better seen as a kink in the
tube.
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