Thin-walled, distended tube; tube wall < 3 mm

Convoluted or S-shaped, oval or pear-shaped, more dilated at fimbriated end

Separate from uterus and ovaries

Content anechoic; low-level echoes suggest acute pelvic inflammatory disease (PID)

Thin endosalpingeal folds (~ 2-3 mm) protrude into lumen

Incomplete septa: Short, linear echogenic projections into lumen from tubal kinking

Waist sign: Indentation of opposing walls of dilated tubal structure resulting in appearance of waist

Beads on string sign: Small hyperechoic mural nodules on transverse imaging

Cogwheel sign: Thicker endosalpingeal folds in acute PID

No color flow in endosalpingeal folds or wall

Color flow in thickened tube suggests acute infection (as well as internal debris)

Pyosalpinx (acute PID)/tuboovarian complex

Cystic ovarian neoplasm

Paraovarian cyst/peritoneal inclusion cyst

Dilated bowel, acute appendicitis

Tubal obstruction from PID, endometriosis, appendicitis, or postpelvic surgery

Usually asymptomatic, can present with pelvic or lower abdominal pain, severe pain may indicate adnexal torsion

Must be distinguished from pyosalpinx or hematosalpinx based on tubal content and clinical picture

Can result in infertility or ectopic pregnancy

Cine clips are very useful for confirmation of tubular configuration

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  Look for incomplete septa and mural nodules in tubular, fluid-filled structure separate from uterus and ovaries

3D-rendered US can help see tortuous structure, which is difficult to follow with 2D imaging