Diagnosis of Pyosalpinx by Hysterosalpingosonography Using Spring Water

Most of the cases of large pyosalpinx or hydrosalpinx may be easily misdiagnosed on ultrasound as a case of a tuboovarian mass or abscess, an endometriotic cyst, or other specific ovarian tumors which may further complicate management. Here we report a case of a female patient who presented with complaints of secondary infertility and clinical impressions of previous sonograms of an endometriotic cyst or tuboovarian mass. In our clinic, ultrasound revealed a complex mass in the left adnexa, predominantly cystic with internal echoes and some solid tissue in the periphery, measuring 9.0 × 8.0 cm in size. She was then subjected to a new modified technique, hysterosalpingosonography (HSS), to test her tubal patency. The characteristic comet tail artifact of micro air bubbles may easily seen entering the left adnexal mass, thus leading to the accurate diagnosis of pyosalpinx. It is recommended that all adnexal complex masses resembling tuboovarian masses, or endometriotic cysts may be further subjected to hysterosalpingosonography with spring water to exclude the clinical entities of pyosalpinx or hydrosalpinx.