CASE 2222 Published on 23.06.2003

Hydrosalpinx. A diagnosis by Hysterosalpingography

Section

Genital (female) imaging

Case Type

Clinical Cases

Authors

Beckett D

Patient

27 years, female

Categories
No Area of Interest ; Imaging Technique Digital radiography
Clinical History
A patient was referred for a hysterosalpingogram with a 2 year history of primary infertility. Preliminary investigations on both patient and partner were unremarkable.
Imaging Findings
The patient was referred for hysterosalingography following a 2 year history of primary infertility. Sexual history stated she had 5 previous partners. Preliminary investigations of both patient and partner were normal. The uterine cavity was cannulated and under fluoroscopic observation 10-15mls of water-soluble contrast was injected. Tubal anatomy and patency were assessed. Hysterosalpingographic findings are shown in figure 1.
A diagnosis of bilateral hydrosalpinx was made and a 5 day course of antibiotic prophylaxis given.
Discussion
Hydrosalpinx is the blockage of the fimbrial end of the fallopian tube most commonly as a result of chronic salpingitis leading to distension by its watery contents. Peritubal adhesions from a salpingotomy, partial salpingectomy or fimbrectomy may also result in hydrosalpinx. The most common presentation is with infertility. The mechanism by which fertility is disrupted is complex and lies in the cyclical response of the tubal isthmus to ovarian estradiol and progesterone. During the preovulatory phase estradiol leads to isthmic mucus secretion in conjunction with stimulation of ampullary transudation of fluid. In addition the isthmic myosalpingeal tone is raised. These events result in a functional occlusion of the fallopian tube with subsequent fluid accumulation and hydrosalpinx. At ovulation the rise in progesterone causes isthmic relaxation allowing the hydrosalpinx fluid into the uterus at a time which coincides with passage of the ovum into the uterine cavity. The hydrosalpinx fluid has been shown to be embryotoxic and can lead to failure of implantation of the embyro in natural and assisted pregnancy.
Treatment options include salpingectomy, salpingostomy or tubal occlusion by a clip. Treatment is advised in patients undergoing IVF since the chances of a normal pregnancy are halved due to the presence of a hydrosalpinx.
Differential Diagnosis List
Bilateral hydrosalpinx
Final Diagnosis
Bilateral hydrosalpinx
Case information
URL: https://www.eurorad.org/case/2222
DOI: 10.1594/EURORAD/CASE.2222
ISSN: 1563-4086