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Hydrosalpinx

A hydrosalpinx refers to a fluid collection in a distended fallopian tube with distal occlusion. The fluid collection results in a dilated and/or tubular like appearance of the fallopian tube. It is a common sequela of pelvic inflammatory disease and a major cause of infertility.


Presentation

Symptoms of hydrosalpinx vary based on the cause and severity of the disease. It frequently occurs following pelvic inflammatory disease (PID). Patients may present with chronic pelvic pain, lower abdominal pain, low-grade fever, vaginal discharge, and/or non-menstrual uterine bleeding. Other patients will be completely asymptomatic except for infertility [1]. Hydrosalpinx has also been associated with tubal and ovarian malignancy. In such cases a patient may describe a feeling of "fullness" in the pelvic region or an adnexal mass [2]. Hydrosalpinx may be unilateral, however, the fallopian tube on the other side is also abnormal in most of the cases.

Gangrene
  • Both patients had bilateral hydrosalpinges with unilateral torsion and gangrene.[ncbi.nlm.nih.gov]
  • Recurrent pelvic pain may signify intermittent noninfarctive torsion, but severe acute pain is a sign of torsion with impending infarction and gangrene in some patients.[ncbi.nlm.nih.gov]
  • Pyosalpinx, especially the gangrenous type, carries a risk of perforation (6), therefore, it was resected in Case 2. Different surgical techniques have been performed for hydrosalpinges.[caribbean.scielo.org]
Camping
  • The present study investigated the possible involvement of cystic fibrosis transmembrane conductance regulator (CFTR), a cAMP-dependent chloride channel, in the pathogenesis of hydrosalpinx.[ncbi.nlm.nih.gov]
  • Moreover, hydrosalpinx inhibited miR-133b expression through the activation of nuclear factor κB/p65, and SGK1 decreased miR-133b-induced HOXA10 expression by phosphorylating cAMP responsive element binding protein in Ishikawa cells.[ncbi.nlm.nih.gov]
  • You’ve probably heard from the two camps, but the point of this article is not to convince you avoid running, but rather to give you an alternative to achieve your fat loss goals if running is not your thing.[livestrong.com]
Weight Loss
  • Hydrosalpinx has been associated with tubal and ovarian malignancy, and therefore questions pertaining to patient or family history of such malignancy and/or recent unexplained weight loss and fatigue may be useful as well.[symptoma.com]
Pelvic Mass
  • Physical exam includes palpation for any adnexal or pelvic mass. A serum or urine pregnancy test should be administered to any woman of child bearing age to rule out tubal pregnancy.[symptoma.com]
  • Generally, a diagnosis of a pelvic mass is made by ultrasound. Recently, CT scan results have been found to correlate with histopathological findings in the patients who had tubo-ovarian abscesses (7).[caribbean.scielo.org]
Hypertension
  • Four obstetric complications were reported including placenta previa, hypertension, maternal diabetes with premature rupture of membranes, and preeclampsia. All infants are well.[ncbi.nlm.nih.gov]
Adnexal Mass
  • There were 55 patients with 67 cystic adnexal masses. Of the 67 cystic adnexal masses, there were 26 hydrosalpinges (39%), 36 cystic ovarian neoplasms (54%), and five paraovarian masses (7%).[ncbi.nlm.nih.gov]
  • Computed tomography clearly delineated the mucosal tumor and characteristic unilateral tubular shaped adnexal mass of the hydrosalpinx which was easily distinguishable from ovarian cystic masses.[ncbi.nlm.nih.gov]
  • Two women who had been sterilized by tubal ligation or cautery experienced recurrent pelvic pain several years later, and cystic adnexal masses were recognized in both patients.[ncbi.nlm.nih.gov]
  • In postmenopausal women presenting with low abdominal pain with an adnexal mass, the gynecologist should contemplate possible torsion of the hydrosalpinx.[ncbi.nlm.nih.gov]
  • Fifty-two patients with fluid-filled adnexal masses suspected of being abnormal fallopian tubes were scanned by two-dimensional and 3D transvaginal ultrasound (TVUS). Six patients had bilateral disease.[ncbi.nlm.nih.gov]
Urinary Retention
  • Urinary retention is a rare condition in women. We report a case of intermittent retention associated with severe anterior displacement of the uterus and cervix caused by a large hydrosalpinx.[ncbi.nlm.nih.gov]

Workup

Workup for hydrosalpinx begins with the patient's medical history, physical exam, and ultrasound imaging. More invasive procedures used to diagnose hydrosalpinx include hysterosalpingography (HSP) and surgical laparoscopy. A history of pelvic inflammatory disease, sexually transmitted disease, endometriosis, infertility, previous lower abdominal or pelvic surgeries, and/or ruptured appendix should be elicited. Hydrosalpinx has been associated with tubal and ovarian malignancy, and therefore questions pertaining to patient or family history of such malignancy and/or recent unexplained weight loss and fatigue may be useful as well. Physical exam includes palpation for any adnexal or pelvic mass. A serum or urine pregnancy test should be administered to any woman of child bearing age to rule out tubal pregnancy.

Transvaginal ultrasonography has a high sensitivity and specificity for diagnosis of hydrosalpinx [2] [3] [4]. Appearance of hydrosalpinx on gray scale ultrasonography consists of an elongated, dilated fallopian tube, with incomplete septations or indentations (commonly referred to as either "waist sign" or "cogwheel"), and anechoic contents [3]. Nodules may or may not be present in the walls; their presence should raise suspicion for ovarian malignancy [5]. Color doppler evaluation can help differentiate hydrosalpinges from ovarian lesions; the former is characterized by flow from the borders and typically high resistance than ovarian flow [6] [4].

Magnetic resonance imaging (MRI) may be used to help identify the nature of the contents of distended fallopian tube [7] [8]. For example, fluid demonstrating a high signal intensity on T1-weighted images is indicative of endometriosis or tubal pregnancy; heterogenous signal intensity in the wall of the tube suggests pylosalpinx resulting from tubo-ovarian abscess; and an enhancing solid mass inside the distended tube is suggestive of tubal carcinoma [9].

Hydrosalpinx is often diagnosed with a HSP. HSP findings demonstrate a dilated, distal fallopian tube showing obstructed fimbria and no spillage of contrast dye into the peritoneum (indicating occlusion) [10].

Laparoscopy allows for confirmatory diagnosis of hydrosalpinx as well as for intervention and treatment such as opening the occluded end of the tube, removal of adhesions, and possible removal of the fallopian tubes in certain cases.

Treatment

  • This study investigated the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following assisted conception treatment[ncbi.nlm.nih.gov]
  • This way, we can be more effective, safe and provide our patients with better treatment results. The review analysed randomised studies, trials and meta-analysis, which give new aspects on the treatment methods for tubal pathology before IVF.[ncbi.nlm.nih.gov]
  • Ten (12%) units did not recommend treatment of hydrosalpinx prior to IVF treatment, while 30 (36%), 27 (33%) and 16 (19%) recommended treatment weakly, strongly and very strongly respectively.[ncbi.nlm.nih.gov]
  • Six patients in the treatment group and five in the control group conceived. Five patients in the treatment group and none in the control group had pregnancy beyond the first trimester and finally reached 36-40 weeks gestational age (P .02).[ncbi.nlm.nih.gov]
  • The aim of this network meta-analysis was to compare the effectiveness of surgical treatments for hydrosalpinx before IVF-ET.[ncbi.nlm.nih.gov]

Prognosis

  • Patients with hydrosalpinx are a recognized group with poor prognosis in in-vitro fertilization. This review presents evidence for the effectiveness of different treatment options.[ncbi.nlm.nih.gov]
  • Success rates achieved through subsequent IVF are typical of outcomes of good-prognosis in similarly aged patients without hydrosalpinx in our same programs, based on 2008 Society for Assisted Reproductive Technologies data.[ncbi.nlm.nih.gov]
  • Since, a hydrosalpinx is associated with poor fertility prognosis removing the tube is usually the best option.[inviafertility.com]
  • Therefore, this treatment method is no longer favored, except in a few cases in which the prognosis is high (such as very young patients with mild tubal disease, one sided blockage with no other identifiable pathology and those who cannot afford IVF treatment[laivfclinic.com]
  • Treatment and prognosis tubal torsion : can be late complication 4,7 General imaging differential considerations include elongated paraovarian cyst cystic ovarian neoplasm(s) : identification of a separate ovary helps distinguish a hydrosalpinx from a[radiopaedia.org]

Epidemiology

  • The Rochester Epidemiology Project (Rochester, MN) was used to identify three cohorts: women who had undergone tubal sterilization and subsequent hysterectomy, women who had undergone tubal sterilization alone, and women who had undergone hysterectomy[ncbi.nlm.nih.gov]
  • In fact, a review of epidemiological literature on running injuries — from as early as 1992 —conducted at the University of Amsterdam in the Netherlands, found that 50 to 75 percent of running injuries are caused to the lower extremities by constant repetition[livestrong.com]
  • The epidemiology of molar pregnancy and choriocarcinoma. Clin Obstet Gynecol 1984; 27: 153. ‎ Pagina 773 - Pediatr 1989:115:105. 56. Boepple PA. Mansfield MJ. Link K. et al.[books.google.ro]
Sex distribution
Age distribution

Pathophysiology

  • The pathology and pathophysiology of hydrosalpinx are reviewed.[ncbi.nlm.nih.gov]
  • The underlying pathophysiology for hydrosalpinx in this population remains unclear. Among our cases, postsurgical adhesions appeared to be the most likely predisposing factor for tubular obstruction.[ncbi.nlm.nih.gov]
  • The hydrosalpinx that is visible on transvaginal sonography is proposed as a new clinical entity by de Wit et al in 1998 10 , although the diagnostic and pathophysiological features of this subgroup are poorly defined.[fogsi.org]
  • The hydrosalpinx that is visible on transvaginal sonography has been proposed as a new clinical entity by de Wit et al .in 1998,[ 10 ] although the diagnostic and pathophysiological features of this subgroup are poorly defined.[ncbi.nlm.nih.gov]

Prevention

  • Tubal infertility is a unique cause for infertility because it usually represents a simple obstruction that prevents sperm and egg from meeting. One specific type of tubal infertility, the hydrosalpinx, is a bit more complicated.[center4fertility.com]
  • Tubal factor infertility is defined as any anatomic abnormality that prevents the sperm and egg from uniting. Tubal disease can be caused by infections or other conditions.[fertilityauthority.com]
  • Hydrosalpinx prevents a fertilized egg from traveling to the womb to implant.[draliabadi.com]
  • This prevents fertilization – and thus pregnancy – by blocking an ovulated egg from moving from the ovary to the fallopian tube for fertilization by the sperm.[fertilitynj.com]
  • Hydrosalpinx may cause infertility by preventing embryos from reaching the uterus. It may also interfere with fertility therapy and cause problems for in vitro fertilization. The fluid in the tube can be expressed out of the tube into the uterus.[herbalremedies.com]

References

Article

  1. Okaro E, Condous G, Khalid A, et al. The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain--can we reduce the need for laparoscopy? BJOG. 2006;113:251-6.
  2. Timor-Tritsch IE, Lerner JP, Monteagudo A, Murphy KE, Heller DS. Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol. 1998;12:56-66.
  3. Sayasneh A, Ekechi C, Ferrara L, et al. The characteristic ultrsound features of specific types of ovarian pathology (Review). Int J Oncol. 2015; 46:445-58.
  4. Smorgick N, Maymon R. Assessment of adnexal masses using ultrasound: a practical review. Int J Womens Health. 2014; 6:857-63.
  5. Patel MD, Acord DL, Young SW. Likelihood ratio of sonographic findings in discriminating hydrosalpinx from other adnexal masses. AJR Am J Roentgenol. 2006;186:1033-8.
  6. Zalel Y, Soriano D, Lipitz S, et al. Contribution of color Doppler flow to the ultrasonographic diagnosis of tubal abnormalities. J Ultrasound Med. 2000 Sep. 19:645-9.
  7. Brown MA, Ascher SM. Adnexa. In: Semelka RC, ed. Abdominal-pelvic MRI. 2nd ed. Hoboken, NJ: Wiley-Liss, 2006; 1334–79.
  8. Outwater EK, Siegelman ES, Chiowanich P. Dilated fallopian tubes: MR imaging characteristics. Radiology1998; 208: 463–9.
  9. Kim MY, Rha SE, Oh SN, Kim M. MR Imaging findings of hydrosalpinx: A comprehensive review. Radiographics. 2009; 29:495-507.
  10. Aboulghar MA, Mansour RT, Serour GI. Controversies in the modern management of hydrosalpinx. Human Reproduction Update. 1998; 4:882-90.

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Last updated: 2018-06-22 12:33