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Hysterosalpingogram
Last revised by Dr MT. Niknejad on 25 Aug 2022
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Hysterosalpingogram (HSG) is a 'uoroscopic
examination of the uterus and the Fallopian
tubes, most commonly used in the
investigation of infertility or recurrent
spontaneous abortions.
On this page:
Article:
Indications
Contraindications
Technique
Complications
Detectable pathology
References
Images:
Cases and Fgures
Indications
Infertility to assess uterine morphology and
tubal patency.
Contraindications
pregnancy
active pelvic infection
recent uterine or tubal surgery
Technique
the procedure should be performed during
the proliferative phase of the patient’s
menstrual cycle (days 6-12), when the
endometrium is thinnest
this improves visualization of the uterine
cavity, and also minimizes the possibility
that the patient may be pregnant 1
if there is any uncertainty about the
patient’s pregnancy status, a beta hCG is
warranted prior to commencing.
after an antiseptic cleaning of the external
genital area, a vaginal speculum is inserted
with the patient in the lithotomy position;
the cervix is cleaned with an aseptic
solution.
catheterization of the cervix is then
performed; the type of device used depends
on local practice preferences
e.g. 6 Fr Foley catheter with balloon
in'ation, or
any one of a range of available HSG
catheters or metal cannulas 3.
whatever the device, it should be primed
with contrast prior to commencing to avoid
the introduction of gas bubbles which may
provide a false positive appearance of a
Flling defect.
water soluble iodinated contrast is
subsequently injected slowly under
'uoroscopic guidance.
some radiologists use iodinated oil (Lipiodol)
as contrast when the indication is for lack of
fertility. Some authors report increased
fertility after its use: this remains
controversial however 8.
a typical 'uoroscopic examination includes a
preliminary frontal view of the pelvis, as well
as subsequent spot images that
demonstrate uterine endometrial contour,
Flled Fallopian tubes and bilateral
intraperitoneal spill of contrast, to establish
tubal patency.
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Complications
Common but self-limiting
abdominal cramping
per vaginal spotting
venous intravasation
Rare but serious
pelvic infection
contrast reaction
Detectable pathology
Conditions which may be detected with HSG
include:
Uterine
uterine congenital anomalies
submucosal uterine Fbroids
uterine malignancy
adenomyosis
intrauterine adhesions
uterine (endometrial) polyps
Tubal
obliteration of fallopian tubes : usually
secondary to previous pelvic in'ammation.
It must be diUerentiated from incomplete
tubal opaciFcation due to tubal spasm, or
underFlling of the uterus with contrast 2
tubal polyps 6
tubal malignancy
hydrosalpinx
salpingitis isthmica nodosa (SIN) 4
tubal spasm 6: can be physiological
salpingectomy
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Cases and (gures
Case 1: normal hysterosalpingogram
Case 2: normal hysterosalpingogram
Case 3: normal
Case 4: showing a septate uterus mimicking didelphys
uterus
Case 5: showing a sub mucosal uterine leiomyoma
Case 6: intra-uterine adhesions
Case 7: showing hydrosalpinx
Case 8: showing intra-uterine adhesions
Case 9
Case 10: unilateral cornual block
Case 11: bilateral cornual block
Case 12: showing a bicornuate uterus
Case 13: obstructed tube post PID
Case 14: unicornuate uterus with blocked fallopian tube
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