Urogenital Imaging

Pyosalpinx

an inflammatory process affecting the Fallopian tubes (see pelvic inflammatory disease). It is often associated with a hydrosalpinx which becomes infected. It usually begins from a bacterial invasion from the vagina or cervix. Early salpingitis is usually negative on imaging. As the disease progresses, purulent exudate results. Pyosalpinx may develop appearing as tubular or bead-like adnexal mass. At hysterosalpingography, if the distal end of the tube is enlarged (hydrosalpinx) and the fimbriae are sealed, antibiotics can be given to prevent the progression to frank pyosalpinx. Ultrasound is the primary modality for the evaluation of hydro- and pyosalpinx, which are seen as tubular channels of low echogenicity. CT is also useful (Fig.1) (Fig.2). The multiplanar capabilities of MRI may be very helpful for the evaluation of the Fallopian tubes, which are seen as high signal tubular areas in T2-weighted images. They are generally low signal in T1-weighted images but sometimes show intermediate to high signal due to proteinaceous or haemorrhagic contents. Sagittal and coronal images assist in the demonstration of the serpinginous nature of these masses and confirm their origin as dilated Fallopian tubes. The relationship between the tubes, ovary and uterus is also well demonstrated.

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Fig.1

a. Axial contrast-enhanced CT section showing a left pyosalpinx (arrow). b. Tubogram performed after drainage of the pyosalpinx confirms continuity with the left Fallopian tube and uterus.
Pyosalpinx, Fig.1 (a)
Pyosalpinx, Fig.1 (b)
Pyosalpinx, Fig.2