Presentation
Severe lower pelvic pain and fever.
Patient Data
Left adnexal multilocular tubular cystic lesion consistent with dilated left fallopian tube, which shows thick enhancing walls. It shows internal debris with fluid fluid level and diffusion restriction. Extensive inflammatory smudging and stranding of the surrounding fat planes.
Normal anteverted uterus which shows IUCD in situ.
Normal size and signal of both ovaries.
Opinion: Findings are impressive of left pyosalpinx.
Case Discussion
Pyosalpinx is complication of pelvic inflammatory disease (PID). Inflammation results in tubal and peritubal adhesions with superimposed obstruction of the fimbrial end. Being unable to drain, the fallopian tube distends with pus, resulting in a pyosalpinx.
Pyosalpinx can be a component of a tubo-ovarian abscess.
Pyosalpinx appears as a dilated tube (hydrosalpinx) yet with tube wall thickened hyperenhancing with surrounding inflammation. Diffusion restriction may be noted like in this case.
Differential possibilities include hematosalpinx.
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