Russin L D
Department of Diagnostic Imaging, Noble Hospital, Westfield, MA 01086.
Semin Ultrasound CT MR. 1988 Apr;9(2):175-82.
Hydrosalpinx following tubal sterilization has been observed with increasing frequency. Women who have had PID or who have used IUDs might be at risk of developing this condition because they may already have occluded tubes from prior salpingitis. If a previously occluded tube is ligated or cauterized so that a second occlusion is created, hydrosalpinx may be anticipated. Often bilateral, hydrosalpinx may be present for years. Recurrent pelvic pain may signify intermittent noninfarctive torsion, but severe acute pain is a sign of torsion with impending infarction and gangrene in some patients. This condition has been detected by ultrasound and CT, enabling preoperative diagnosis. Presumably it will also be imaged by MR. Nontorsive hydrosalpinx is usually imaged as a thin-walled adnexal cyst. Torsion with infarction is seen as a larger cystic structure with thicker walls and internal debris from venous congestion and internal hemorrhage. Since 25 of 30 patients with post-tubal sterilization hydrosalpinx have presented with acute torsion, the significance of a nontorsive hydrosalpinx detected by any imaging modality should not be disregarded. Surgical removal or percutaneous puncture and drainage should be considered. Awareness of the patient's medical history is the key to diagnosis.
输卵管绝育术后输卵管积水的发生率日益增加。曾患盆腔炎或使用过宫内节育器的女性可能有患此病的风险，因为她们先前的输卵管炎可能已导致输卵管堵塞。如果对先前已堵塞的输卵管进行结扎或烧灼，从而造成第二次堵塞，就可能会出现输卵管积水。输卵管积水通常为双侧性，可能存在数年。反复出现的盆腔疼痛可能意味着间歇性非梗死性扭转，但严重的急性疼痛则表明在某些患者中存在即将发生梗死和坏疽的扭转。这种情况已通过超声和CT检测出来，从而实现术前诊断。据推测，磁共振成像（MR）也能对其进行成像。非扭转性输卵管积水通常成像为薄壁附件囊肿。伴有梗死的扭转则表现为较大的囊性结构，壁更厚，且有因静脉淤血和内出血导致的内部碎屑。由于30例输卵管绝育术后输卵管积水患者中有25例出现急性扭转，因此通过任何成像方式检测到的非扭转性输卵管积水的重要性都不应被忽视。应考虑手术切除或经皮穿刺引流。了解患者的病史是诊断的关键。
