Hydrosalpinx (Chronic Pelvic Inflammatory Disease)

Introduction

• Description: Recurrent or chronic adnexal infections may result in a cystic dilation of the fallopian tube (hydrosalpinx), which may present as an adnexal mass.

• Prevalence: 40% of female infertility is a result of tubal damage, including the most severe form, hydrosalpinx.

• Predominant Age: 15–25 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Recurrent or chronic adnexal infection. This is the end stage condition of pyosalpinx.

• Risk Factors: Early (age) sexual activity, multiple sexual partners, pelvic inflammatory disease, sexually transmitted infections (STIs; Chlamydia, gonorrhea), uterine instrumentation (hysterosalpingography, intrauterine contraceptive device placement, endometrial biopsy, dilation and curettage), and douching. Damage from previous surgery or adhesions can also cause hydrosalpinx.

Signs and Symptoms

• Asymptomatic (most common).

• Vague lower abdominal pressure or chronic pelvic pain.

• Infertility.

• Unilateral or bilateral cystic masses (often elongated or sausage-shaped). Data indicate that a clinical diagnosis of symptomatic pelvic inflammatory disease has a positive predictive value for salpingitis of only 65%.

Diagnostic Approach