IS Case 343: Pyosalpinx

Amira Farouga, MD

Imaging Sciences URMC

2009 URMC Imaging Sciences
Publication Date: 2009-11-09


Patient is an 18-year-old female, G1P1 with a history of treated chlamydia, presenting with severe left lower quadrant pain and adnexal tenderness.


Elongated, thick walled tubular structure with complex fluid inferior to the ovary.




Transvaginal sonography recognizes the dilated fluid-filled fallopian tube by its tubular shape, somewhat folded configuration, and well-defined echogenic walls.

The dilated tube can be distinguished from a fluid-filled bowel loop by the lack of peristalsis. Low level internal echos may be seen within the fluid-filled tube as a result of pus (pyosalpinx), and a fluid-pus level may occasionally be seen.

Anechoic fluid within the tube indicates hydrosalpinx. A thickened tubal wall (5mm or more) is indicative of acute disease.


  1. Patel MD, Acord DL, Young SW. Likelihood ratio of sonographic findings in discriminating hydrosalpinx from other adnexal masses. AJR Am J Roentgenol. 2006 Apr;186(4):1033-8. PMID: 16554575

3 images