Hydrosalpinx with fimbrial block

Left Hydrosalpinx with Fimbrial Block – Hysterosalpingography

Left hydrosalpinx with fimbrial block refers to distal obstruction of the left fallopian tube at the fimbrial end, resulting in dilatation of the tube with accumulation of fluid. It is commonly caused by pelvic inflammatory disease, genital tuberculosis, endometriosis, or post-surgical adhesions. On hysterosalpingography (HSG), the affected tube appears dilated, elongated, and tortuous with clubbing of the fimbrial end and absence of free peritoneal spill (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing left hydrosalpinx with fimbrial block. The left fallopian tube is markedly dilated and tortuous with a clubbed distal end and no peritoneal spill (arrow). The right tube shows normal opacification and free spill.

Findings: The uterine cavity is normal in size and contour. The left fallopian tube is dilated, elongated, and serpiginous, terminating in a blind, club-shaped distal end. No free intraperitoneal contrast spill is seen on the left. The right fallopian tube is patent with free spill.

Conclusion: Hysterosalpingographic features are consistent with left hydrosalpinx with fimbrial block.

Patient Symptoms

Patients may present with primary or secondary infertility, chronic pelvic pain, dyspareunia, or a history of pelvic infection. Some cases are asymptomatic and detected during infertility evaluation.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. Delayed images may demonstrate contrast retention within the dilated tube, helping to confirm fimbrial occlusion.

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. Hydrosalpinx should be reported carefully due to its negative impact on fertility outcomes.

Related Conditions

Differential diagnoses include distal tubal block without dilatation, peritubal adhesions, pyosalpinx, and tubo-ovarian mass. Laparoscopy or pelvic MRI may be required for confirmation and management planning.

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Declaration

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