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Salpingitis Isthmica Nodosa

Valerie L Ward, MD
Harry Z Mellins, MD

December 20, 1995

Presentation

A 29-year-old woman with a history of pelvic inflammatory disease (PID) and primary infertility.

Imaging Findings

Hysterosalpingography

Hysterosalpingography (HSG) shows that the fallopian tubes are normal in size and position. However, there are many small, round periluminal outpouchings (arrow) of contrast from the isthmic (proximal) portion of both tubes. The tubes are patent. The uterus is normal, and there are small round lucencies at the uterine fundus which are air bubbles (arrow). On subsequent images, the air bubbles are no longer present.

Differential Diagnosis

Salpingitis isthmica nodosa is the most likely diagnosis because of the patient's history of PID and the HSG appearance of periluminal diverticular collections of contrast confined to the isthmic portion of the fallopian tubes. Intravasation of contrast during HSG appears as a linear distribution of contrast parallel to the tubal lumen. Tuberculous salpingitis appears as calcification and segmental dilation of the tubes. Tubal endometriosis has a honeycombed appearance of the isthmic portion of the tube and is associated with thicker diverticula.

Diagnosis

Salpingitis isthmica nodosa

Discussion

Salpingitis isthmica nodosa is also referred to as tubal diverticulosis. HSG demonstrates multiple small diverticular collections of contrast protruding from the lumen into the wall of the isthmic portion of the fallopian tubes. Histologically, the up to 2 mm sized diverticula represent hypertrophied tubal mucosa that penetrates the myosalpinx (i.e. muscular wall of the tube). There is secondary hyperplasia and hypertrophy of the surrounding myosalpinx, and hence at laparoscopy, localized nodular thickening or swelling of the isthmus is identified.

The etiology of salpingitis isthmica nodosa is unknown, however it may be a postinfectious reaction. Patients have histologic evidence of previous salpingitis and may have high serum chlamydial antibody titers. Salpingitis isthmica nodosa predisposes to a higher rate of primary infertility by interfering with upward sperm migration and ectopic pregnancy by trapping the fertilized ovum within the tube. Hence the diagnosis of salpingitis isthmica nodosa by HSG is important in the management of the infertile patient.

References

1. Karasick S, Karasick D. Atlas of hysterosalpingography. Illinois: Charles C Thomas, 1987: 123-134.

2. Yoder I. Hysterosalpingography and pelvic ultrasound: imaging in infertility and gynecology. 1st ed. Boston: Little Brown, 1988: 50-51.

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