The "waist sign" of a dilated fallopian tube.

Vol.:(0123456789)1 3 Abdominal Radiology (2021) 46:2985–2986 https://doi.org/10.1007/s00261-020-02901-z CLASSICS IN ABDOMINAL RADIOLOGY The "waist sign” of a dilated fallopian tube Frank Chen1 · Manoj K. Jain1 · Shweta Bhatt1 Received: 15 September 2020 / Revised: 31 October 2020 / Accepted: 4 December 2020 / Published online: 2 January 2021 © The Author(s) 2021 “Waist sign” refers to diametrically opposed indentations along the walls of tubular cystic structure and has been lik - ened in appearance to a human waist (Figs. 1, 2). An adnexal cystic lesion with positive waist sign and a tubular shape is considered pathognomonic for hydrosalpinx. Hydrosalpinx is a relatively common condition that occurs when the amp- ullary segment of the fallopian tube becomes obstructed and the tube becomes distended by accumulated secretions. The most common cause of hydrosalpinx is sequela of prior pel- vic inflammatory disease, with less common causes includ- ing tubal ligation, endometriosis, and adhesions resulting from pelvic surgeries, tubal pregnancy, and tubal neoplasm [1]. Most patients with hydrosalpinx are asymptomatic, but some patients may present with recurrent pelvic pain or infertility [2 ]. It is important to differentiate hydrosalpinx from other adnexal cystic lesions, especially ovarian cystic neoplasms, as hydrosalpinx is often treated conservatively if asymptomatic. The waist sign was first described in hydrosalpinx on ultrasound, but can also be seen on CT and MRI [3]. Besides a positive waist sign and tubular shape, other imaging fea- tures on ultrasound that are suggestive of hydrosalpinx include incomplete septa that result from the fallopian tube folding upon itself and thickened longitudinal folds that have a “cogwheel” appearance when imaged in cross-section, seen with chronic pelvic inflammatory disease [4]. * Shweta Bhatt [email protected] 1 Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA 2986 Abdominal Radiology (2021) 46:2985–2986 1 3 Compliance with ethical standards Conflict of Interest All authors, Frank Chen, Manoj K Jain, and Shwe- ta Bhatt, declare that they have no conflicts of interest. Open Access This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. References 1. Kim MY, Rha SE, Oh SN, et al. (2009) MR imaging find- ings of hydrosalpinx: a comprehensive review. Radiographics 29(2):495-507. 2. Rezvani M, Shaaban AM. (2011) Fallopian tube disease in the nonpregnant patient. Radiographics 31(2):527-548. 3. Patel MD, Acord DL, Young SW. (2006) Likelihood ratio of sonographic findings in discriminating hydrosalpinx from other adnexal masses. AJR Am J Roentgenol 186(4):1033-1038. 4. Brown DL, Dudiak KM, Laing FC. (2010) Adnexal masses: US characterization and reporting. Radiology 254(2):342-354. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Fig. 1 Color Doppler ultra- sound image of the right adnexa shows a tubular, avascular, cystic structure with a “waist” (arrows), consistent with a hydrosalpinx Fig. 2 Diagrammatic illustration of a dress with a conspicuous waist