HYDROSALPHINX
Ahydrosalpinx is ablocked, dilated, fluid-filled fallopian tube
Hydrosalpinxmay occur as an isolated adnexal lesion or as one component of a complexadnexal lesion that has caused distal tubalocclusion . The most common cause of distal tubal occlusion and hydrosalpinx ispelvic inflammatory disease. Other causes include endometriosis, peritubaladhesions from a previous operation, tubal cancer, and tubal pregnancy.
Ultrasound
• thin-or thick-walled (in chronic cases)
• elongatedor folded, tubular, C-shaped, or S-shaped fluid-filled structure
• distinctfrom the uterus and ovary.
.Thefolds may produce a characteristic “cogwheel” appearance when imaged in crosssection. These folds are pathognomonic of a hydrosalpinx. Indentations on theopposite sides of the wall is referred to as the waist sign which is a strongpredictor of hydrosalpinx. The waist sign in combination with a tubular-shapedcystic mass has been found to be pathognomonic of a hydrosalpinx.The ‘beads-on-a-string’ sign is described as hyperechoicmural nodules measuring about 2–3 mm and seen on cross-section of thefluid-filled distended structure
Sometimesthe dilated fallopian tube may not show longitudinal folds. If the elongatednature of these folds is not noted, they may be mistaken for mural nodules ofan ovarian cystic mass. A significantly scarred hydrosalpinx may present as amultilocular cystic mass with multiple septa (often incomplete) creatingmultiple compartments. These septa are generally incomplete, and thecompartments can be connected. However, with more pronounced scarring,differentiation from an ovarian mass may not be possible.
(a) “Waist sign” of a hydrosalpinx, marked by the asterisks, asseen with 2-D ultrasound.
(b) “Beads on a string” sign of a hydrosalpinx demonstrated by 2-Dultrasound
(c) Sagittal view -nodular appearance of longitudinal folds atjunction of collapsed and distended segments
(d)Transverse sonograms show distended funneled distal end ofhydrosalpinx
(e) Image showing incomplete septae
(f) No flow seen with color Doppler
(g) Cogwheel sign-swollen walls and swollen mucosal folds
Numerousstudies have shown that hydrosalpinges have a detrimental effect on IVF successrates. Two meta-analyses of these studies noted that the pregnancy,implantation, and delivery rates were approximately 50% lower and that thespontaneous abortion rate was higher in the presence of hydrosalpinges . Thisfinding may be due to mechanical flushing of the embryos from the uterinecavity, decreased endometrial receptivity, or a direct embryotoxic effect .Patients with hydrosalpinges visible on ultrasound may be more significantlyaffected . Randomized clinical trials (RCTs) comparing pregnancy rates andoutcomes with IVF forwomen with hydrosalpinges, with or without prior laparoscopic salpingectomy,reported that salpingectomy restores the rates of pregnancy and live birth tolevels similar to those of women without hydrosalpinx
ACochrane analysis concluded that laparoscopic salpingectomy or occlusion shouldbe considered before IVF for women with communicating hydrosalpinges . Evenpatients with a unilateral hydrosalpinx have been shown to have lower pregnancyrates with IVF . Unilateral salpingectomy resulted in a significant improvementin IVF pregnancy rates in these patients . However, salpingectomies forbilateral hydrosalpinges yielded higher IVF pregnancy rates than for unilateralhydrosalpinges
