Air Bubbles artifact in Hysterosalpingography

Air Bubbles (artifact in HSG)

Air bubbles are a common technical artifact encountered during hysterosalpingography, usually introduced during contrast injection. On imaging, they appear as small, round, well-defined intraluminal filling defects within the uterine cavity or fallopian tubes. These should be carefully differentiated from true pathological filling defects such as polyps or synechiae, as air bubbles typically change position or dissolve on delayed images (Fig. 1).

Fig-1

Fig. 1—Air bubbles seen during hysterosalpingography. Small, round, well-defined filling defects are noted within the uterine horn, representing intraluminal air bubbles. These defects do not conform to the uterine contour and may change position on delayed images (arrows).

Findings: Multiple small, smooth, round intraluminal filling defects are seen within the uterine horn. The defects are non-adherent, show positional change on delayed imaging, and do not cause distortion of the uterine cavity.

Conclusion: Imaging features are consistent with air bubbles introduced during contrast injection. No evidence of true intrauterine pathology is identified.

Procedure (Hysterosalpingography)

The study is performed in the early proliferative phase (day 7–10). Under aseptic conditions, a cervical cannula is placed and contrast is injected slowly under fluoroscopic guidance. Careful attention is paid to eliminate air from the syringe and tubing prior to injection.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Slow, continuous injection helps reduce inadvertent air introduction.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Leech–Wilkinson cannula / Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing (air-free)
• Antiseptic solution
• Fluoroscopy unit

Contrast volume typically ranges from 8–12 mL. Prior to injection, all syringes and tubing should be flushed with contrast to eliminate air.

Safety Considerations

Introduction of air should be minimized to prevent diagnostic confusion. Pregnancy must be excluded prior to the study. Mild cramping is common and self-limiting.

Related Conditions

Air bubbles may mimic intrauterine polyps, synechiae, blood clots, or tubal filling defects. Repeat imaging or delayed films help distinguish air bubbles from true pathology.

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Declaration

This case is presented for educational purposes only. No patient-identifiable information is disclosed, and ethical standards for anonymized imaging data are maintained.