Contribution of color Doppler flow to the ultrasonographic diagnosis of tubal abnormalities

The human tubal lavage proteome reveals biological processes that may govern the pathology of hydrosalpinx

Hydrosalpinx, the blockage of fallopian tubes, can result from pelvic inflammatory disease. Hydrosalpinx is a cause of infertility and negatively impacts in vitro fertilization. To better understand the pathobiology of hydrosalpinx, we compared the proteome of lavages from disease vs. healthy fallopian tubes. Results indicate a disruption of redox homeostasis and activation of the complement system, immune cell infiltration, and phagocytosis; pathways that may drive tubal injury. To our surprise among the most prominent proteins with hydrosalpinx was mesothelin (MSLN), which until now has only been associated with epithelial malignancies. Analogous to mesothelioma and ovarian carcinoma, a significant increase of MSLN was detected in plasma from patients with hydrosalpinx. This finding suggests MSLN may provide clinical diagnosis in lieu of the current approaches that require invasive imaging. Importantly, these findings implicate MSLN in a benign disease, indicating that the activation and role of MSLN is not restricted to cancer.

Fallopian tube torsion in the pediatric age group: radiologic evaluation

Fallopian tube torsion is a rare but important cause of acute pelvic pain in young adolescent girls. It is a surgical emergency treated with either detorsion or salpingectomy. The imaging findings can be nonspecific and challenging. However, an accurate early diagnosis is essential for prompt surgical treatment. Our objective was to review whether imaging findings can be specific enough to suggest the diagnosis of tubal torsion prospectively in the appropriate clinical setting. An Institutional Review Board-approved retrospective review of our imaging database from 2005 to 2012 revealed 10 surgically proven cases of fallopian tube torsion. All cases had sonography performed; 5 cases had additional multidetector computed tomography. All 10 patients (9-17 years) presented with acute pelvic pain. Sonographic findings included dilated tubular structures in 6 of 10 cases: adjacent to a normal ipsilateral ovary in 5 of 6 and adjacent to a benign ovarian teratoma in 1. In 4 cases, no dilated tube was identified; 3 of 4 had a cystic mass separate from the ovaries, and 1 had the imaging appearance of a multicystic ovary. Computed tomographic findings in the 5 cases that underwent multidetector computed tomography included a dilated tubular structure in 3 of 5; 2 of 5 had a cystic adnexal mass identified. Although rare, tubal torsion should be considered in female adolescents with acute pelvic pain. Sonography should be the first imaging choice. When a tubular structure or a midline cystic mass associated with a normal ipsilateral ovary is noted, tubal torsion should be considered in the differential diagnosis.

Hydrosalpinx in a Woman With a Partial Hysterectomy

Hydrosalpinx is a condition where the fallopian tube becomes obstructed and fills with fluid. Bilateral hydrosalpinx is most commonly associated with a pelvic infection. However, there may also be an association between partial hysterectomy and hydrosalpinx, which typically presents unilaterally. Although it is often difficult to visualize a normal fallopian tube, endovaginal sonography has proven to be a useful tool in the visualization and diagnosis of hydrosalpinx and other fallopian tube abnormalities. It is important to consider hydrosalpinx in the differential diagnosis when presented with a patient with a history of partial hysterectomy with associated pelvic pain. This case presents a woman with severe right lower quadrant pain with a history of partial hysterectomy. A pelvic sonogram revealed evidence of a unilateral hydrosalpinx. Postsurgical findings confirmed the diagnosis of right-sided hydrosalpinx and pelvic adhesions.

Primary leiomyoma of the fallopian tube: preoperative ultrasound findings

Leiomyoma of the fallopian tube is extremely rare. Most cases are asymptomatic and found incidentally at autopsy or unrelated operation. These leiomyomas tend to be singular, small, and unilateral, with a resultant rare preoperative diagnosis. They are often managed with laparotomy, as seen in the literature review. Therefore, preoperative imaging is never reported. We describe a case of leiomyoma of the fallopian tube, which was suspected before operation and treated by laparoscopic approach. Transvaginal ultrasound clearly showed a hypoechoic solid mass separate from the left ovary and uterus in a 44-year-old woman. Color Doppler ultrasound detected low impedance flow in this mass. Diagnostic laparoscopy and the follow-up laparoscopic salpingoectomy revealed a primary leiomyoma of the fallopian tube. We conclude that powerful ultrasound could be helpful in diagnosing rare gynecologic disorders but laparoscopy can be used for definite diagnosis and management of such disorders.