Hydrosalpinx on Radiology Reports: What It Means

ByA. Mendelson, MD
Please read the disclaimer

Hydrosalpinx means a fallopian tube is blocked and filled with fluid. On an ultrasound report, it tells you the sonographer saw a fluid-filled, tube-shaped structure next to the ovary. This finding can be silent or related to pelvic pain or difficulty getting pregnant. Below is a plain-English article focused on what the ultrasound is showing, why it matters, and what typically happens next.

What is a hydrosalpinx?

A hydrosalpinx forms when one or both fallopian tubes become blocked at the far end near the ovary. Fluid produced inside the tube cannot drain, so the tube stretches and fills with clear fluid. Common causes include prior pelvic infection, pelvic inflammatory disease (PID), endometriosis, cancer or scarring after surgery. Sometimes no clear cause is found.

How ultrasound detects hydrosalpinx

Ultrasound uses sound waves to make real-time pictures of the pelvis. For suspected hydrosalpinx, the transvaginal ultrasound probe is most helpful because it gives a closer, sharper look at the uterus, ovaries, and tubes.

Typical ultrasound features of a hydrosalpinx include:

  • A long, curved, fluid-filled structure that looks “tubular” rather than round

  • Thin walls, often folded on themselves, creating a “sausage-like” shape

  • Incomplete internal bands or thin septations from the folded tube walls

  • Diameter that can change along its course, sometimes with gentle “waist” indentations

  • Minimal or no blood flow inside on color Doppler when it is simply fluid

Radiologists often describe it as a “tubular anechoic structure adjacent to the ovary consistent with hydrosalpinx.” Anechoic means it is black on ultrasound because it is filled with fluid.

Helpful ultrasound signs your report may mention

  • Waist sign: gentle, symmetric indentations along the tube

  • Beads-on-a-string sign: tiny bumps along the inner wall from healed inflammation, seen in chronic cases.

  • Cogwheel sign: thicker, more prominent inner folds that can appear with active inflammation.

These signs help distinguish a hydrosalpinx from an ovarian cyst or a paraovarian cyst, which are usually rounder and lack the characteristic tubular course and inner folds.

Right, left, or both sides

Your report will state where it is seen. Hydrosalpinx can be on the right side, left side, or on both sides. If both tubes are dilated, the report may use terms like “bilateral hydrosalpinges.”

Size and measurements

Ultrasound measurements often include the widest diameter of the dilated tube and its length. Size can help your clinician track changes over time and correlate with symptoms. A very large, tense hydrosalpinx may cause pressure or pain; a small one may be found incidentally.

Doppler and why it matters

Color Doppler looks for blood flow. A simple hydrosalpinx is just fluid and typically shows no internal blood flow. If there is active infection or inflammation, surrounding tissues may look thicker and more vascular. Your report might then suggest clinical correlation for infection or recommend additional evaluation.

What an ultrasound cannot always tell

An ultrasound can show the tube is fluid-filled and likely blocked, but it cannot reliably tell exactly where the blockage is or how severe the scarring may be. It also cannot predict natural fertility by itself. That is why clinicians sometimes order additional tests.

Additional imaging or tests you might see ordered

  • Hysterosalpingography (HSG): an X-ray study with contrast through the cervix to see if contrast spills through the tubes.

  • Pelvic MRI: occasionally used for complex cases or when ultrasound views are limited.

  • Repeat ultrasound: to document stability, improvement, or progression, especially after treatment.

Symptoms and clinical context

Some people have no symptoms. Others have pelvic discomfort, pressure, or difficulty conceiving. Hydrosalpinx can be a marker of prior inflammation in the pelvis. If you are trying to become pregnant, especially with assisted reproduction, the presence of hydrosalpinx is important to discuss because it can lower implantation and success rates if untreated.

How hydrosalpinx affects fertility

The trapped fluid in a hydrosalpinx can sometimes leak back into the uterus, creating a less friendly environment for an embryo to implant. This is why fertility specialists often evaluate and treat significant hydrosalpinx before in vitro fertilization (IVF). Typical options include removing the affected tube (salpingectomy) or blocking it near the uterus (proximal occlusion) to prevent backflow of fluid.

Treatment overview from the imaging point of view

Ultrasound does not treat the hydrosalpinx, but it guides the care plan:

  • If the ultrasound shows a simple, fluid-filled tube and you have no symptoms, your clinician may discuss watchful waiting or fertility-focused planning.

  • If there are signs of infection (fever, pain, elevated white blood cells) and ultrasound shows thickened, inflamed tube walls or complex fluid, antibiotics and close follow-up are common.

  • If you are planning IVF, your fertility team may use ultrasound findings to recommend salpingectomy or occlusion to improve IVF outcomes.

Your specific plan will depend on symptoms, fertility goals, and your overall health.

What to expect during the ultrasound

A pelvic ultrasound usually starts with a transabdominal scan (probe on the lower belly) with a full bladder. Most of the detailed evaluation is done transvaginally with an empty bladder for comfort. The transvaginal portion takes a few minutes and gives the clearest view of the tubes and ovaries. Gel is used for sound conduction; there is no radiation.

Common phrases you may see on the report

  • “Tubular anechoic structure adjacent to the ovary, compatible with hydrosalpinx.”

  • “Dilated fallopian tube with internal folds/septations.”

  • “Color Doppler without internal vascularity, no solid components identified.”

  • “Recommend gynecologic correlation” or “consider HSG” for further evaluation.

These phrases are standard and help your doctor connect the imaging with your symptoms and plans.

When the diagnosis is uncertain

Sometimes the tube is not clearly seen, or a cystic structure is close to the ovary and its origin is unclear. In those cases, your radiologist may say “possible hydrosalpinx” or “cystic adnexal structure.”  Follow-up ultrasound or pelvic MRI may be needed.

Safety and limitations

Ultrasound is safe and uses no radiation. The main limitation is that fallopian tubes are thin when normal and only become visible when filled or inflamed. Body habitus, bowel gas, and prior surgery can also limit views. If the study is technically limited, the report will say so.

Key takeaways

  • Hydrosalpinx is a fluid-filled, blocked fallopian tube.

  • Ultrasound shows a tubular, anechoic structure with characteristic signs that help confirm the diagnosis.

  • The finding matters most for fertility planning and when symptoms are present.

  • Additional tests like HSG or MRI may be used to refine the plan.

  • Treatment depends on symptoms and goals; for IVF, addressing a significant hydrosalpinx often improves success rates.

A clear ultrasound report is the first step. Share it with your gynecologist or fertility specialist so imaging and clinical decisions line up with your goals.

References

https://radiopaedia.org/articles/hydrosalpinx?lang=us

https://my.clevelandclinic.org/health/diseases/24437-Hydrosalpinx

https://pubs.rsna.org/doi/full/10.1148/rg.2020200051

Disclaimer: The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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