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Hydrosalpinx

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
  • 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): 
    • 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
    • this is from accumulation of tubal secretions caused by surgical blockage proximally and adhesion-related blockage distally
  • tubal ligation 
  • tubal malignancy: primary or secondary tumours of the fallopian tubes

Radiographic features

Ultrasound

May be seen as a thin-or thick-walled (in chronic cases), elongated or folded, tubular, C shaped or S shaped fluid-filled structure that is 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 “cogwheelappearance when imaged in cross section. These folds are pathognomonic of a hydrosalpinx.

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.  

Hysterosalpingogram

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

CT

A hydrosalpinx may be seen incidentally at CT as a fluid-attenuation tubular juxta-uterine structure that is 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 characterisation and localisation 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 hypo-intense although can be hyper-intense if there is proteinaceous fluid
  • T1 C+ (Gd): the the mucosal plicae and the tube walls may show mild enhancement 
  • T2: hyper-intense

Complications

Differential diagnosis

General imaging differential considerations include: 

  • elongated para ovarian cyst
  • elongated pelvic perineural 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 extra ovarian 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

See also

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