Presentation
Assessment of fertility. Unable to conceive in 2 years.
Patient Data
As part of a hysterosalpingogram the cervix was cannulated and contrast filled a normal shaped endometrial cavity. There are no filling defects within the uterine cavity and the outline is smooth and regular. Multiple nodular diveriticulae are identified along the isthmal portion of the right fallopian tube. No peritoneal spill was seen on this side.
Contrast flowed freely down the left fallopian tube with prompt spill into the peritoneum.
Findings suggest salpingitis isthmica nodosa of the right fallopian tube with possible tubal occlusion. The left fallopian tube is patent and the uterus appears normal.
Case Discussion
Salpingitis isthmica nodosa (SIN) (sometimes also referred to as perisalpingitis isthmica nodosa - PIN) refers to nodular scarring of the fallopian tubes.
The prevailing theories include an inflammatory (salpingitis), a congenital, and more recently an acquired (but not post-inflammatory) etiology.
A characteristic finding is multiple nodular diverticular spaces involving the fallopian tubes (usually involving the proximal 2/3 of the fallopian tubes). A hysterosalpingogram (HSG) of the nodular area with severe SIN shows several pockets (diveritculae) containing the introduced contrast material.
There is an increased risk of tubal ectopic pregnancy.