Hematosalpinx

A hematosalpinx refers to intraluminal blood within the Fallopian tube (often dilated). 

Pathology

Causes include

• tubal ectopic pregnancy: common cause ¹
• endometriosis: common cause ⁵
• tubal carcinoma
• pelvic inflammatory disease
• fallopian tube torsion
• retrograde menstruation
  • uterine cervical stenosis
• pelvic trauma ⁵

Radiographic features

Ultrasound

May demonstrate a dilated fallopian tube where altered blood products within the tube are often demonstrated as homogeneous low-level echoes.

CT

Blood products within the distended fallopian tube may be seen as high attenuation on CT. 

Pelvic MRI

The distended tube can be high signal intensity on T1-weighted fat-suppressed imaging due to blood products. Blood products may cause adhesions to fold or pull the ovaries and fallopian tubes toward the midline, a finding known as the “kissing ovary” sign. The adhesions may also encase the ovary, resulting in an appearance similar to that of a complex cystic solid mass, although this feature is not specific. 

Practical points

• in a woman with a negative B-hCG, consider endometriosis.

See also

• hydrosalpinx
• pyosalpinx