Hydrosalpinx

Definition

• A hydrosalpinx develops when distal or proximal tubal occlusion causes the fallopian tube to fill with fluid and distend.

Occurrence & epidemiology

Epidemiology

• Tubal disease is involved in up to about 35% of cases of infertility.
• In a cohort after acute PID, 26.7% had a sonographic suspicion of hydrosalpinx after three months.

Aetiopathogenesis

Aetiology

• A hydrosalpinx is most often related to previous acute pelvic inflammatory disease, but it can also accompany a current acute salpingitis.

Clinical features

• In assisted reproduction, hydrosalpinx is associated with lower implantation and pregnancy rates and a higher risk of ectopic pregnancy and miscarriage.
• Proposed mechanisms include impaired endometrial receptivity and a toxic effect of the tubal fluid on early embryos.

Diagnosis

Typical imaging findings

• Ultrasound: Beside the ovary runs an elongated, anechoic, repeatedly folded cavity. Incomplete septa project from its wall into the lumen without dividing it fully; there are no solid parts.

• On ultrasound an elongated, convoluted cystic structure with anechoic or hypoechoic content and incomplete septa is typical; the septa are seen in up to 85–93% of chronic hydrosalpinges.
• Hyperechoic mural nodules of 2–3 mm (beads-on-a-string sign), which correspond to flattened, fibrotic remnants of the mucosal folds, indicate chronic hydrosalpinx.
• A thickened tubal wall and a cogwheel sign, by contrast, indicate acute salpingitis.
• In a meta-analysis of women with adnexal masses, transvaginal ultrasound reached a pooled sensitivity of 84% and a specificity of 99%.
• The gold standard is histological confirmation, although direct laparoscopic visualisation is also accepted.
• On CT and MRI hydrosalpinx appears as a fluid-filled, thin-walled tubular structure without wall enhancement, hyperintense on T2 and hypointense on T1 MRI.

Keep learning in the app

Further reading (selection)

1. Transvaginal Ultrasound Accuracy in the Hydrosalpinx Diagnosis: A Systematic Review and Meta-Analysis (Diagnostics (Basel) 2023, PubMed Central)

Cross-references