Hydrosalpinx (HSG)

Bilateral Hydrosalpinx – Hysterosalpingography

Bilateral hydrosalpinx refers to dilatation of both fallopian tubes due to distal tubal obstruction, most commonly at the fimbrial ends, resulting in accumulation of serous fluid. It is usually secondary to pelvic inflammatory disease, genital tuberculosis, endometriosis, or post-surgical adhesions. On hysterosalpingography (HSG), both tubes appear dilated, elongated, and tortuous with clubbed distal ends and absence of free peritoneal spill on either side (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing bilateral hydrosalpinx. Both fallopian tubes are dilated, elongated, and tortuous with clubbed distal ends and no free intraperitoneal spill (arrows).

Findings: The uterine cavity is normal in size and contour. Both fallopian tubes demonstrate marked dilatation with serpiginous configuration and blind-ending distal segments. No intraperitoneal contrast spill is seen bilaterally. Delayed images may show contrast retention within both tubes.

Conclusion: Hysterosalpingographic features are consistent with bilateral hydrosalpinx.

Patient Symptoms

Patients commonly present with primary or secondary infertility. Some may have chronic pelvic pain, dyspareunia, or a prior history of pelvic infection. Bilateral hydrosalpinx is strongly associated with reduced fertility.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. Delayed images are helpful to demonstrate contrast retention within the dilated tubes, confirming distal tubal obstruction.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Approximately 6–10 mL of contrast is injected slowly under fluoroscopic guidance.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Leech–Wilkinson cannula
• Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

Excessive injection pressure should be avoided to prevent tubal rupture or intravasation. Bilateral hydrosalpinx should be clearly reported due to its significant negative impact on natural conception and assisted reproductive outcomes.

Related Conditions

Differential diagnoses include distal tubal block without dilatation, peritubal adhesions, pyosalpinx, and tubo-ovarian masses. Laparoscopy or pelvic MRI may be required for definitive diagnosis and treatment planning.

---

Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.