3D Sonographic Diagnosis of Hydrosalpinx: Implications for the Non-Laparoscopy Confirmation of Pelvic Inflammatory Disease
Authors: Fernandez Carlos , Levine Elliot , Sodini Irma , Juna Jacqueline 
Published: July 2024

Introduction: As Pelvic Inflammatory Disease (PID) has many clinical and radiographic features, the specific utility of sonographic imaging for its diagnostic confirmation may be helpful with its non-invasive approach, rather than the common reliance on the operative procedure of laparoscopy for this purpose. Since the presence of hydrosalpinx is commonly associated with PID, its associated three-dimensional transvaginal sonography (3DTVS) appearance may offer helpful diagnostic certainty. Although Timor-Tritsch introduced a sonographic technique for its display previously in 2005, the technique used in this current imaging project may be somewhat simpler to employ and possibly even more revealing. A case series was investigated for the possible diagnosis of deep invasive endometriosis (DIE), for which patients presented with pelvic pain presumed to represent DIE. A separate case series was investigated for the possible value of the O-RADS app for the diagnosis of ovarian malignancy. Since the sonographic diagnosis of hydrosalpinx was made in each dataset, and some of those patients underwent exploratory surgery, the veracity of the sonographic diagnosis could be calculated. As pelvic pain could also represent possible PID, the cases in which hydrosalpinx were found were specifically examined for it. The present investigation was performed in order to detail the value of 3D surface rendering imaging for hydrosalpinx and its ultimate diagnosis. Some patients underwent operative intervention and thus histologic confirmation, in addition to the sonographic evaluation which all patients had performed. It is the intent of this investigation to display the value of 3DTVS to diagnostically determine some cases of chronic pelvic pain as being due to PID.

Methods: A series of 32 patients were sonographically evaluated with 3DTVS for complaints of pelvic pain, and when a hydrosalpinx was observed, a particular technique was employed (described below). Nine of those patients had a surgical intervention in addition to the ultrasound evaluation. The technique that was used can be described as follows. The 3D volume of the region of interest (ROI) was obtained, and it was manipulated to produce the best image of the hydrosalpinx. A large Ultrasound rendering box was created to demonstrate the external surface of the resultant 3D hydrosalpinx image.

Results: A total of 32 patients underwent the described rendering imaging with 3DTVS. Of those patients, 9 (27 %) also underwent surgical exploration. 78 % of those cases revealed surgical findings consistent with the presurgical sonographic diagnosis.

Conclusion: From the review of this case series, it appears that the sonographic diagnosis of chronic PID can virtually be relied upon with 3DTVS, rather than subject all patients to laparoscopy for whom this diagnosis may be considered. One can consider the described technique as a method of performing a partial “Virtual Laparoscopy”. After sonographically confirming the diagnosis of chronic PID, a gynecologist can confidently use the available medical therapeutic methods for its treatment, and if such treatment fails improvement of the patient’s symptoms, surgical extirpation can be considered (e.g. TAH-BSO). In this way, 3DTVS can be considered as an important gynecologic diagnostic tool for the described purpose. The rendered images increased the confidence in diagnosing hydrosalpinx.