Fig. 3.1
(a) Balloon obscured lower uterine segment after initial placement. (b) balloon deflated at the end of study. (c) Uterine congenital anomalies, typically with a single external cervical os, can be difficult to interpret. The most common problem occurs in the complete bicornuate or septate uterus and can simulate a unicornuate uterus if the catheter is positioned into the lower uterine segment. Photo shows correct position of the catheter
A variety of technical problems may occur, such as malfunction of the instuments used (which can be easily avoided by checking the equipment carefully before the start of study). Anatomic abnormalities, or patient discomfort can cause termination of the examination (Figs. 3.1c, 3.2 and 3.3). Complications can involve pain and discomfort, injury and bleeding, vascular intravasation (<5%), contrast material reactions [3], post-procedure infection, mortality, pregnancy radiation (Fig. 3.4).
Fig. 3.2
Spherical filling defect represents air bubble
Fig. 3.3
(a, b) Right fallopian tube failed to opacify despite left tubal filling and a peritoneal spillage. Right tube is seen along with peritoneal spillage, although anatomic obstruction may be the cause. Technical problems, cornuate spasm, and mucous plugging are other considerations
Fig. 3.4
Vascular intravasation
Post-procedural pregnancy rates are not well known and have not been thoroughly investigated. Possibilities of treatment include mechanical lavage of tubes, release of peritubal adhesions, stimulation of the cilia of the tubal mucosa, alteration of the cervical mucous, and a bacteriostatic effect.
Indications and Contraindications
Indications for HSG
Infertility
Recurrent spontaneous abortions
Postoperative evaluation following tubal ligation or reversal of tubal ligation
Preoperative evaluation prior to myomectomy
Contraindications for HSG
Pregnancy
Active pelvic infection
Radiographic Anatomy
The fallopian tubes serve as the passageway for the ovum to travel from the ovary to the uterus. They are 10–12 cm in length and course along the superior aspect of the broad ligament [5–6]. Each fallopian tube can be divided radiographically into three segments. The interstitial or cornual region is the short segment that traverses the muscular wall of the uterus; the isthmic portion is the longest of the three segments and is the narrow segment between the interstitial and ampullary regions; the ampullary portion is the widened region near the ovary [7–8]. The fimbriated part is the funnel-shaped end of the tube and is not usually seen in HSG (Figs. 3.5, 3.6, 3.7, 3.8, 3.9, 3.10 and 3.11).
Fig. 3.5
Tube segments: intramural, isthmic, ampullary
Fig. 3.6
Variants of normal uterine fundus. (a) straight, (b) concave, (c) convex
Fig. 3.7
Linear lucencies are seen at both corneal tubal junctions
Fig. 3.8
The endocervical borders can appear serrated normally and should not be confused with endocervicitis. The mucosa of the endocervix forms small parallel folds, the plicae palmatae, to create a finely serrated margin
Fig. 3.9
Bilateral fallopian tube patency shown by intraperitoneal dispersion of contrast media
Fig. 3.10
Spiculation of uterine cavity, when found in the upper uterus, suggests adenomyosis
Fig. 3.11
“Clumping” – suggesting peritubal adhesions
General Diagnostic Principles
- A.
Endocervical canal:
Straight and long endocervical canal (Fig. 3.12)
Filling defects: polyp (Fig. 3.13)
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