1) The document discusses haematometrocolpos and haematosalpinx, which are conditions where blood or fluid accumulates in the uterus or fallopian tubes due to obstruction. 2) Causes of obstruction include acquired issues like cervical stenosis or radiation fibrosis, and congenital issues like an imperforate hymen. 3) Key ultrasound findings that can help identify these conditions are outlined, including a distended endometrial cavity and vagina in haematometrocolpos, and cogwheel, beads on a string, and waist signs in haematosalpinx.

1. 
Dr Arun Gupta
Director imaging
Dr Rakhee gupta
Dr Vinayak Mittal
 Dr Kiran
Dr Ritesh Mahajan

ADVANCED USG LOUNGE
GYNAECOLOGY
IMAGING SERIES
HAEMATO-METROCOLPOS
HAEMATOSALPINX

2. DEFINITION

Obstruction in the genital
tract leads to accumulation of
the blood / fluid in the uterus
( Metro) / and or Vagina (
colpos) : location depending
upon the level of obstruction.
Before menstruation it is fluid
which accumulates
( Hydrometrocolpos) . After
menstruation it is blood
( Haematometrocolpos) .
ETIOLOGY

Acquired Etiology :
 Cervical stenosis from
endometrial / endocervical
malignancies .
 Post Radiation fibrosis .

Congenital Etiology :
 Imperforate hymen.
 Vaginal septum
 Vaginal atresia.
 Rudimentary uterine horn.

3. HAEMATOMETROCOLPOS
DISTENDED
ENDOMETRIAL
CAVITY AND
GROSS DISTENSION
OF THE UPPER
VAGINA IN A YOUNG
GIRL .
SAGITTAL MR IMAGE
USG WITH E/O DEBRIS IN THE
DISTENDED UPPER VAGINAL CAVITY
(SEQUAEL TO HAEMORRAGE PRODUCTS)

4. ASSOCIATED
ARCUATE MORPHOLOGY
TRANSVERSE EXTENSION OF THE
ENDOMETRIAL CAVITY WITH
INDENTATION OF THE UPPER
CENTRAL PART OF THE
ENDOMETRIAL CAVITY BY THE
THICK MYOMETRIUM IS S/O
ARCUATE MOORPHOLOGY
CORONAL MR IMAGE

5. HAEMATOMETROCOLPOS
HAEMATOMETROCOLPOS
Fluid filled distended
endometrial /
endocervical canal
with gross distension
of the upper vagina
( periforniceal
region).
Mass effect is
appreciated on dome
of the UB and
Rectosigmoid colon
also ) .
Etiology :
Imperforate
Hymen
SAGITTAL MR IMAGE
CORROBORATIVE USG IMAGE

6. SAGITTAL SCAN SHOWS
FLUID DISTENSION OF THE
UPPER VAGINAL CAVITY .
CORONAL SCAN SHOWS FLUID
DISTENSION OF THE VAGINAL
CAVITY .

7. 


The fallopian tubes are not
usually visualized on a routine
transvaginal sonographic
examination unless outlined by
fluid. Fallopian tubes are best
visualized on sonography
when thickened or fluid-filled .
Thickened tubal wall ( >=
5mm) is s/o Acute Etiology .
Pyosalphinx develops as a
result of the tubal occlusion.







Tubal ectopic pregnancy
Endometriosis
Tubal carcinoma
Pelvic inflammatory disease
Fallopian tube torsion
Retrograde menstruation
 Uterine cervical stenosis
Pelvic trauma

8. 
Cogwheel sign .
 Cogwheel shaped structure visible in the cross section of the tube with
thickened tubal walls is s/o Acute disease .

Beads on string sign .
 Hyperechoic mural nodules sized 2 mm to 3mm are appreciated along
the inner contour of the tubal wall representing degenerated and
flattened endosalpingeal fold remnants and seen only in chronic
disease.

Incomplete septae / waist sign .
 Triangular protrusions emanating from one side of the tubal wall but
not reaching the other side are seen quite often in both acute /
chronic disease processes and are non discriminatory .
 Tubular filled mass with diametrically opposite indentations has most
likelihood of being a tubal lesion than other adnexal mass ( waist sign)
.

9. FLUID LEVEL IN THE
ENDOMETRIAL CAVITY
(HAEMORRHAGE SEQUAEL)
(CASE OF ENDOMETRIOSIS)
DIFFUSE INCREASE IN THE
MYOMETRIAL
VASCULATURE ON
POWER DOPPLER
ADENOMYOSIS SEQUAEL

10. DISTENDED TUBULAR
STRUCTURE WITH
INCOMPLETE SEPTAE
/INVAGINATIONS IS
S/O DILATED
FALLOPIAN TUBE
DEBRIS IN THE DISTENDED
TUBE WAS
HAEMOORRHAGE IN THIS
CASE OF ENDOMETTRIOSIS
Blood products may cause adhesions to fold
or pull the ovaries and fallopian tubes
toward the midline, a finding known as the
KISSING OVARY
sign.

11. Tubular filled Lesion with
diametrically opposite
indentations has most likelihood
of being a tubal lesion than other
adnexal mass ( waist sign)
NOTE
Potential pitfalls in the diagnosis of
hematosalpinx / hydrosalpinx include
paratubal, paraovarian, or perineural
cysts

12. DIAGNOSTIC
ULTRASOUND
FOURTH EDITION
Carol M. Rumack, MD, FACR
J. William Charboneau, MD,
FACR
Deborah Levine, MD, FACR