Modalities to Diagnose Hydrosalpinx

1. Ultrasonography

• The fallopian tube becomes visible on USG only when it gets distended with fluid, blood, or pus.
• It appears like cystic lesion with septa and often confused with an ovarian cystic mass or fluid collections in the adnexa.
• This may appear as – Thin or thick walled (in chronic cases), elongated or folded, tubular, C-shaped, or S-shaped fluid-filled structure, distinct from the uterus and ovary.
• Longitudinal folds that are present in a normal fallopian tube may become thickened in the presence of a hydrosalpinx. The folds may produce a characteristic “cogwheel” appearance when imaged in cross section.
• Incomplete septae may also give a “beads on a string” sign.
• A significantly scarred hydrosalpinx may present as a multi-locular cystic mass with multiple septa (often incomplete) creating multiple compartments. The use of a 3D volume can connect cystic lesions lying in various planes and improve the diagnostic ability of USG.

2. CT

A hydrosalpinx may be seen incidentally at CT as a fluid-attenuation tubular adnexal structure, separate from the ovary. A simple hydrosalpinx is not accompanied by pelvic inflammation. The tubal wall may enhance following contrast.

3. MRI

MR imaging is the modality of choice for the characterization and localization of adnexal masses that are inadequately evaluated with ultrasound. MR imaging also may be useful for determining the cause of a hydrosalpinx or its associated adnexal process by characterizing the nature of the contents of the dilated tube

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