Objective To study the clinical value of multi-slice spiral CT in the diagnosis of tubal ovarian abscess and hydrosalpinx. Methods 67 cases of patients with tubal ovarian abscess and hydrosalpinx in the hospital were selected as the research objects. All patients were confirmed by surgery and pathology. There was tubal ovarian abscess in 39 cases and hydrosalpinx in 28 cases. The Siemens Sensation 64 slice spiral CT machine was used to examine the patients. The CT imaging features of tubal ovarian abscess and hydrosalpinx were analyzed. Results There were 87 fallopian tube lesions detected in 67 cases of patients. All patients were with visible, bilateral uterine cystic and mixed density masses, including tubular type in 56 cases, polycystic type in 15 cases and single cystic type in 16 cases. There were tubal ovarian abscesses of tubular type in 35 cases, polycystic type in 7 cases and single cystic type in 2 cases; hydrosalpinx of tubular type in 22 cases, polycystic type in 8 cases and single cystic type in 13 cases. The main features of ovarian abscesses were thick wall masses, blurred boundaries and clear inner wall. After enhancement scan, there were homogeneous or layering enhancement while there was no enhancement in the liquid part. Stripes around masses and fat density increased. The CT findings of hydrosalpinx mainly were cystic masses, polycystic and tubular, in which the incidence rate of polycystic shape was significantly higher than that of tubal ovarian masses, with clear wall light. After enhancement scan, the enhancement was slight. Conclusion Multislice spiral CT can accurately identify tubal ovarian abscess and hydrosalpinx. Through analyzing the differences in CT imaging of the two kinds of diseases, reliable basis can be provided for making treatment plan.