Pyosalpinx (HSG)

Right Cornual Block with Left Pyosalpinx – Hysterosalpingography

This represents a mixed proximal–distal tubal pathology, with obstruction at the right uterotubal junction (cornual block) and inflammatory dilatation of the left fallopian tube (pyosalpinx). Pyosalpinx refers to accumulation of pus within an obstructed fallopian tube, usually secondary to pelvic inflammatory disease or genital tuberculosis. On hysterosalpingography (HSG), asymmetric tubal findings are seen with non-opacification of the right tube and a dilated, irregular left tube without free peritoneal spill (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing right cornual block with left pyosalpinx. The right fallopian tube fails to opacify beyond the uterine cornu, while the left tube is dilated, irregular, and tortuous with no peritoneal spill (arrows).

Findings: The uterine cavity is normal in size and contour. On the right side, contrast terminates abruptly at the cornual region with no tubal visualization. On the left side, the fallopian tube is dilated with irregular walls and a clubbed distal end, consistent with pyosalpinx. No free intraperitoneal spill is seen.

Conclusion: Hysterosalpingographic features are consistent with right cornual block and left pyosalpinx.

Patient Symptoms

Patients may present with primary or secondary infertility, chronic pelvic pain, fever, lower abdominal pain, abnormal vaginal discharge, or a prior history of pelvic inflammatory disease. Acute symptoms may be absent in chronic pyosalpinx.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. Careful low-pressure contrast injection is essential, especially when an infected or inflamed tube is suspected.

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. A limited volume (5–8 mL) 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

HSG should be performed cautiously in suspected active infection. Excessive injection pressure must be avoided to prevent tubal rupture or dissemination of infection. Active pelvic infection is a relative contraindication.

Related Conditions

Differential diagnoses include right cornual spasm, left hydrosalpinx, tubo-ovarian abscess, genital tuberculosis, and severe peritubal adhesions. Ultrasound, MRI, or laparoscopy may be required for confirmation and management.

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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.