Last revised by Joshua Yap on 25 Oct 2022

Pyosalpinx refers to a fallopian tube that is filled, and often distended, with pus.

A pyosalpinx often tends to be a complication of background pelvic inflammatory disease (PID). Inflammation results in tubal and peritubal adhesions with superimposed obstruction of the fimbrial end. Pyosalpinx can be a component of a tubo-ovarian abscess. Being unable to drain, the fallopian tube distends with pus, resulting in a pyosalpinx.

A pyosalpinx may be seen as a thickened fallopian tube and may or may not be associated with debris. The fallopian tube may be distended.

  • dilated serpentine/tubular structure in the pelvis

  • low-level echoes due to the higher protein content of the debris within the tube distinguish a pyosalpinx from a hydrosalpinx 4,6

Morphological appearances of a pyosalpinx can sometimes be indistinct from simple uncomplicated tubal dilatation (hydrosalpinx1. As opposed to a simple hydrosalpinx, in pyosalpinx the tube wall may appear thickened 3 and have hyperenhancing tubal walls with surrounding inflammation.

Signal characteristics within the tubular lumen have been described as 5

  • T1: variable due to varying protein content

  • T2: often hyperintense, with characteristic amorphous shading

  • T1 C+ (Gd): thick rim enhancement

  • DWI/ADC: restricted diffusion in the fallopian tube

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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