Hydrosalpinx

Dr Pradosh Kumar Sarangi and Radswiki et al.

Hydrosalpinx is a descriptive term and refers to a fluid-filled dilatation of the fallopian tube.

Clinical presentation

Patients may be asymptomatic or may present with pelvic pain or infertility.

Pathology

One or both fallopian tubes may be affected. A hydrosalpinx results from an accumulation of
secretions when the tube is occluded at its distal end (obstruction of the ampullary segment) or
both ends. On rare occasions, transient distention of the fallopian tubes occurs because of
retrograde passage of blood from the uterus without complete distal occlusion.

Causes

 endometriosis (often hematosalpinx)

 ovulation induction

 pelvic inflammatory disease (e.g chlamydial or gonococcal infection): a hydrosalpinx is

most commonly a sequela of adhesions from pelvic inflammatory disease

 post-hysterectomy (without salpingo-oophorectomy)

o unilateral or bilateral hydrosalpinx may also occur in women after hysterectomy

when only the fallopian tubes are left to protect the blood supply to the ovary

o this is from accumulation of tubal secretions caused by surgical blockage

proximally and adhesion-related blockage distally
  tubal ligation

 tubal malignancy: primary or secondary tumors of the fallopian tubes

Radiographic features

Ultrasound

 thin- or thick-walled (in chronic cases)

 elongated or folded, tubular, C-shaped, or S-shaped fluid-filled structure

 distinct from the uterus and ovary.

Longitudinal folds that are present in a normal fallopian tube may become thickened in the
presence of a hydrosalpinx. The folds may produce a characteristic “cogwheel” appearance when
imaged in cross section. These folds are pathognomonic of a hydrosalpinx. Indentations on the
opposite sides of the wall is referred to as waist sign which is a strong predictor of
hydrosalpinx. The waist sign in combination with a tubular-shaped cystic mass has been found to
be pathognomonic of a hydrosalpinx 9. Incomplete septae may also give a "beads on a string"
sign.

Sometimes the dilated fallopian tube may not show longitudinal folds. If the elongated nature of
these folds is not noted, they maybe mistaken for mural nodules of an ovarian cystic mass. A
significantly scarred hydrosalpinx may present as a multi-locular cystic mass with multiple septa
(often incomplete) creating multiple compartments. These septa are generally incomplete, and
the compartments can be connected. However, with more pronounced scarring, differentiation
from an ovarian mass may not be possible.

CT

A hydrosalpinx may be seen incidentally at CT as a fluid-attenuation tubular adnexal structure,

separate from the ovary. A simple hydrosalpinx is not accompanied by pelvic inflammation. The
tubal wall may enhance following contrast.
MRI

MR imaging is the modality of choice for the characterization and localization of adnexal masses
that are inadequately evaluated with ultrasound. A dilated fallopian tube is interposed between
the uterus and ovary and demonstrates fluid signal intensity. Incomplete septa or folds can be
seen. The mucosal plicae are usually effaced, and the tube wall is uniformly smooth and thin.

Signal characteristics of the dilated tube(s) include:

 T1: typically hypointense although can be hyperintense if there is proteinaceous fluid

 T2: hyperintense

 T1 C+ (Gd): the the mucosal plicae and the tube walls may show mild enhancement

Hysterosalpingogram

Will classically show a dilated fallopian tube, filling with contrast and with absence of free
spillage.

Treatment and prognosis

 tubal torsion: can be late complication 4,7

Differential diagnosis

General imaging differential considerations include

 elongated paraovarian cyst

 cystic ovarian neoplasm(s): identification of a separate ovary helps distinguish a

hydrosalpinx from a cystic ovarian mass, an important distinction because malignancy is
rare with an extraovarian cystic adnexal mass
 bowel obstruction: at the pelvic level with dilated bowel loops : a dilated tube can be
distinguished from pelvic bowel loops from the lack of peristalsis

 dilated pelvic veins: pelvic veins can be recognized from the presence of moving low-
level internal echoes, and blood flow may be detectable on Doppler interrogation

 elongated pelvic perineural cyst