(Ultrasound Review) Often tubal pathology is misdiagnosed as ovarian in origin. The two most reliable signs for identifying tubal pathology are the elongated shape and the presence of septa of the tubal wall.
In this study of 25 women with fallopian tube masses, grayscale and color Doppler were used to characterize lesions and possibly differentiate between acute and chronic tubal disease. The study was published in the Journal of Ultrasound in Medicine.
There were 18 women with hydrosalpinx, one with a tubo-ovarian abscess, and one with a tubal torsion. Findings were confirmed at laparoscopy, laparotomy, hysterosalpingography, or abscess drainage.
Transvaginal ultrasound imaging was performed using a 4-7-MHz or 6.5-MHz transducer. Color Doppler parameters were adjusted for maximum sensitivity to low flow. Pulsed-wave Doppler was used to obtain velocity waveforms from the mass, and the resistive index (RI) was calculated.
Ultrasound characteristics of hydrosalpinx included elongated cystic lesion in the adnexa pouch of Douglas with thin borders, clear fluid, and an RI of 0.75. In contrast, a tubo-ovarian abscess showed thick borders with turbid fluid and a mean RI of 0.45.
For abscesses, the abundant vessels had high flow, with a lower vascular resistance. This is typically found with inflammatory conditions.
Color Doppler representing wall vasculature was demonstrated in all cases, with the exception of the tubal torsion, and there was a significant difference in RI comparing acute and chronic tubal conditions.
"The addition of color Doppler flow sonography to the investigation of chronic pelvic pain can distinguish between hydrosalpinx and dilated veins, as is the case with pelvic congestion syndrome," the authors said. "The addition of color Doppler flow sonography in investigating the suspected tubal lesions may reduce the false-positive cases."
The authors conclude that color and pulsed Doppler should be used whenever a tubal abnormality is demonstrated to further characterize the type of lesion.
J Ultrasound Med 2000; 19:645–649
Yaron Zalel et al
Ultrasound Unit, Obstetrics and Gynecology Dept, Sheba Medical Center, Tel Hashomer 52621, Israel
By Ultrasound Review
December 29, 2000
Copyright © 2000 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
