Endometriosis - hematosalpinx

Case contributed by Glen Lo

Presentation

Preoperative endometriosis mapping. A prior ultrasound has diagnosed endometriosis, referred to an endometriosis subspecialist surgeon for operative opinion and you're asked to report an MRI but nobody included the prior imaging report in the referral, or where it was done.

Patient Data

Age: 35
Gender: Female
mri

ANTERIOR COMPARTMENT: normal.

MIDDLE COMPARTMENT:

Uterus: Anteverted anteflexed 67 mm long with normal morphology. Endometrium 5 mm thin

and regular. Junctional zone not thickened. No myometrial lesions. Reduced mobility.

Ovaries: No endometrioma.

Fallopian tubes: There is a left hematosalpinx, with the dilated tube contents homogeneous

T1 bright, T2 shaded, inseparable from the left ovary and left uterosacral ligament and posterior uterus. 

POSTERIOR COMPARTMENT:

Rectosigmoid colon: Minimal superficial tethering.

Pouch of Douglas: Minimal superficial tethering.

Torus uterinus: Superficial linear T2 dark fibrotic thickening without tethering of the adjacent

rectum.

Uterosacral ligaments: normal.

Rectovaginal septum: normal.

INCIDENTAL FINDINGS: None.

Case Discussion

Left hematosalpinx. Fallopian tubes are readily demonstrated on MRI as tubular structures with incomplete septa and can be filled with fluid (hydrosalpinx), blood (hematosalpinx) or pus (pyosalpinx).  

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