Cobblestone fallopian tubes on hysterosalpingogram followed by bilateral tubal abscesses and sepsis

Case notes

A 34-year-old woman, gravida 0, presented for primary infertility evaluation after 1 year attempting to conceive. She had an unremarkable routine laboratory evaluation. She denied a history of sexually transmitted infections or pelvic inflammatory disease and underwent routine hysterosalpingogram (HSG). Grossly abnormal bilateral hydrosalpinges with innumerable, subcentimeter, fixed, multinodular filling defects with a cobblestone appearance were described ( Figure 1 ). Despite being treated with appropriate postprocedure doxycycline for infection prophylaxis, she presented 2 weeks later with bilateral tuboovarian abscesses found on ultrasound examination ( Figure 2 ) and met criteria for sepsis. She was treated with parenteral antibiotics with resolution of her active infection. Several months later, she underwent a laparoscopic bilateral salpingectomy in preparation for in vitro fertilization. Laparoscopy revealed perihepatic adhesions as well as multiple pelvic and peritoneal adhesions and confirmed large bilateral hydrosalpinges ( Figure 3 ). The surgical specimen was sent for pathologic evaluation that revealed histologic findings consistent with xanthogranulomatous salpingitis associated with intraluminal endometriosis ( Figures 4 and 5 ).