Salpingitis isthmica nodosa (HSG)

Salpingitis Isthmica Nodosa – Hysterosalpingography

Salpingitis isthmica nodosa (SIN) is a chronic tubal disorder characterized by multiple epithelial-lined diverticula arising from the isthmic portion of the fallopian tube. It is strongly associated with infertility and ectopic pregnancy. On hysterosalpingography (HSG), SIN classically demonstrates multiple small, rounded contrast-filled outpouchings along the isthmus, producing a characteristic beaded or nodular appearance.

Fig-1

Fig. 1—Hysterosalpingogram demonstrating salpingitis isthmica nodosa. Multiple small, round, contrast-filled outpouchings are seen arising from the isthmic segment of the fallopian tube, giving a nodular appearance (arrows).

Findings: The uterine cavity is normal in size and contour. One or both fallopian tubes show clusters of tiny diverticular outpouchings along the isthmic portion. Tubal lumen may appear narrowed with delayed or absent peritoneal spill.

Conclusion: Hysterosalpingographic features are characteristic of salpingitis isthmica nodosa.

Patient Symptoms

Most patients present with primary or secondary infertility. Some may have a history of ectopic pregnancy, chronic pelvic pain, or previous pelvic inflammatory disease.

Procedure (Hysterosalpingography)

The study is performed in the early proliferative phase of the menstrual cycle. Slow, controlled contrast injection is important to avoid tubal spasm and to clearly delineate the diverticula.

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, and 5–10 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, as it may exaggerate tubal diverticula or cause intravasation. Active pelvic infection is a contraindication.

Related Conditions

Differential diagnoses include tubal diverticulosis, genital tuberculosis, hydrosalpinx, cornual spasm, and post-inflammatory tubal scarring. Laparoscopy may be required for definitive assessment.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.