Dr Arun Gupta Director imaging

Dr Rakhee gupta Dr Vinayak Mittal

Dr Kiran Dr Ritesh Mahajan

HAEMATO-METROCOLPOS

HAEMATOSALPINX

ADVANCED USG LOUNGE

GYNAECOLOGY IMAGING SERIES

HAEMATOMETROCOLPOS

DEFINITION

Obstruction in the genital tract leads to accumulation of the blood / fluid in the uterus ( Metro) / and or Vagina ( colpos) : location depending upon the level of obstruction. Before menstruation it is fluid which accumulates ( Hydrometrocolpos) . After menstruation it is blood ( Haematometrocolpos) .

ETIOLOGY

Acquired Etiology : Cervical stenosis from

endometrial / endocervical malignancies .

Post Radiation fibrosis . Congenital Etiology :

Imperforate hymen. Vaginal septum Vaginal atresia. Rudimentary uterine

horn.

DISTENDED ENDOMETRIAL CAVITY AND GROSS DISTENSION OF THE UPPER VAGINA IN A YOUNG GIRL .

HAEMATOMETROCOLPOS

SAGITTAL MR IMAGE

USG WITH E/O DEBRIS IN THE DISTENDED UPPER VAGINAL CAVITY (SEQUAEL TO HAEMORRAGE PRODUCTS)

TRANSVERSE EXTENSION OF THE ENDOMETRIAL

CAVITY WITH INDENTATION OF THE UPPER CENTRAL

PART OF THE ENDOMETRIAL CAVITY BY THE THICK MYOMETRIUM IS S/O

ARCUATE MOORPHOLOGY

CORONAL MR IMAGE

ASSOCIATED ARCUATE MORPHOLOGY

HAEMATOMETROCOLPOS

Fluid filled distended endometrial / endocervical canal with gross distension of the upper vagina ( periforniceal region).

Mass effect is appreciated on dome of the UB and Rectosigmoid colon also ) .

Etiology :

Imperforate Hymen

HAEMATOMETROCOLPOS

SAGITTAL MR IMAGE CORROBORATIVE USG IMAGE

CORONAL SCAN SHOWS FLUID DISTENSION OF

THE VAGINAL CAVITY .

SAGITTAL SCAN SHOWS FLUID DISTENSION OF THE UPPER VAGINAL

CAVITY .

HAEMATOSALPINX

The fallopian tubes are not usually visualized on a routine transvaginal sonographic examination unless outlined by fluid. Fallopian tubes are best visualized on sonography when thickened or fluid-filled .

Thickened tubal wall ( >= 5mm) is s/o Acute Etiology .

Pyosalphinx develops as a result of the tubal occlusion.

Tubal ectopic pregnancy

Endometriosis  Tubal carcinoma Pelvic inflammatory dis

ease  Fallopian tube torsion Retrograde menstruati

on Uterine cervical

stenosis  Pelvic trauma

Three patterns of tubal wall structure help to assess acute versus chronic

etiology and to differentiate tubal from other cystic lesion.

Cogwheel sign . Cogwheel shaped structure visible in the cross section of the tube with

thickened tubal walls is s/o Acute disease .

Beads on string sign . Hyperechoic mural nodules sized 2 mm to 3mm are appreciated

along the inner contour of the tubal wall representing degenerated and flattened endosalpingeal fold remnants and seen only in chronic disease.

Incomplete septae / waist sign . Triangular protrusions emanating from one side of the tubal wall

but not reaching the other side are seen quite often in both acute / chronic disease processes and are non discriminatory .

Tubular filled mass with diametrically opposite indentations has most likelihood of being a tubal lesion than other adnexal mass ( waist sign) .

FLUID LEVEL IN THE ENDOMETRIAL CAVITY

(HAEMORRHAGE SEQUAEL)(CASE OF ENDOMETRIOSIS)

DIFFUSE INCREASE IN THE

MYOMETRIAL VASCULATURE ON POWER DOPPLER

ADENOMYOSIS SEQUAEL

DISTENDED TUBULAR

STRUCTURE WITH INCOMPLETE

SEPTAE /INVAGINATIONS IS S/O DILATED FALLOPIAN TUBE

DEBRIS IN THE DISTENDED TUBE WAS

HAEMOORRHAGE IN THIS CASE OF

ENDOMETTRIOSIS

Blood products may cause adhesions to fold or pull the ovaries and fallopian tubes

toward the midline, a finding

known as the KISSING OVARY sign.

NOTE Potential pitfalls in the

diagnosis of hematosalpinx / hydrosalpinx include

paratubal, paraovarian, or perineural cysts

Tubular filled Lesion with diametrically opposite indentations has most

likelihood of being a tubal lesion than other adnexal

mass ( waist sign)

WAIST SIGN

REFERENCE

DIAGNOSTICULTRASOUNDFOURTH EDITIONCarol M. Rumack, MD, FACRJ. William Charboneau, MD, FACRDeborah Levine, MD, FACR