Beads on a string sign (chronic salpingitis)
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The beads on a string sign is used to refer to the classic ultrasound morphologic changes of the fallopian tubes as a result of chronic salpingitis.
The "string" alludes to the notably thin salpingeal wall, while the hyperechoic mural nodules constitute the "beads" 1.
Chronic inflammation and fibrosis of the involved salpinx results in fimbrial or ostial occlusion; lack of outflow results in fluid accumulation, leading to tubal distension and progressive mural distension and effacement. The endosalpingeal folds are also involved, flattening and eventually fibrosing. These fibrotic, irregular structures appear as 2-3 mm mural nodules protruding into the tubal lumen 1.
The ultrasound finding of a distended, thin-walled tubular salpinx with 2-3 mm hyperechoic mural nodules protruding at irregular intervals into a fluid-filled lumen is highly suggestive of chronic salpingitis 2.