Salpingitis isthmica nodosa

Salpingitis isthmica nodosa (SIN), sometimes also referred to as perisalpingitis isthmica nodosa - PIN, refers to nodular scarring of the fallopian tubes. In very early stages, the tubes may appear almost normal. As scarring and nodularity progress, the changes become more radiographically apparent.

Salpingitis isthmica nodosa, as the name implies, is irregular benign extensions of the tubal epithelium into the myosalpinx mainly at the isthmic/proximal portion. It is associated with reactive hypertrophy and sometimes inflammation.

Aetiology
  • the aetiology of SIN has remained a matter of controversy since its first description
  • the prevailing theories include an inflammatory (salpingitis), a congenital, and more recently an acquired (but not post-inflammatory) aetiology
Location

It can involve the entire fallopian tube, but usually involves the proximal two-thirds of the fallopian tube.

An accurate radiographic diagnosis is important due to its high association with infertility and ectopic pregnancy.

Hysterosalpingography (HSG)

A characteristic finding is multiple nodular diverticular spaces involving the fallopian tubes, usually involving the proximal two-thirds of the fallopian tubes.

HSG of the nodular area with severe SIN shows several pockets (diverticula) containing the introduced contrast material 5.

It is observed that no dominant channel is seen as the contrast flows through the tube. This means there appears to be no direct pathway for sperm to travel which increases the chances of a tubal pregnancy.

Treatment can be considered with recanalisation procedures either using a catheter guided by interventional radiology or by endoscopic surgery.

Complications:

The term is derived from salpingitis for inflammation of the salpinx (tube), isthmica for the involvement of the proximal isthmic portion of fallopian tube and nodosa for its nodular appearance.

Considerations include:

  • tubal tuberculosis 6
    • often multiple constrictions can form along the course of the fallopian tube due to scarring, and give rise to a "beaded" appearance of the tubes on HSG
    • can also have adnexal calcification
  • endometriosis
  • tubal adenomyosis
Share article

Article information

rID: 12356
System: Gynaecology
Section: Pathology
Synonyms or Alternate Spellings:
  • SIN
  • Salpingitis isthmica nodosa (SIN)
  • Perisalpingitis isthmica nodosa (PIN)
  • Perisalpingitis isthmica nodosa
  • Peri-salpingitis isthmica nodosa

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.