Arcuate Uterus (Hysterosalpingography)
Arcuate uterus is a mild congenital Müllerian duct anomaly characterized by a slight concave indentation of the uterine fundus into the endometrial cavity. It represents near-complete fusion and resorption of the Müllerian ducts and is considered a normal anatomical variant rather than a true malformation. On hysterosalpingography, a single uterine cavity is seen with a shallow, smooth, saddle-shaped fundal indentation (Fig. 1).
|
| Fig-1 |
Findings: Single uterine cavity with normal overall shape and volume. The fundal indentation is broad and shallow, measuring less than 1 cm in depth. Both cornua are symmetric. Fallopian tubes are usually normal with free peritoneal spill.
Conclusion: Hysterosalpingographic appearance is consistent with an arcuate uterus.
Patient Symptoms
Most patients are asymptomatic. Arcuate uterus is generally not associated with infertility or adverse pregnancy outcomes, although it may be incidentally detected during infertility evaluation.
Procedure (Hysterosalpingography)
The study is performed during the early proliferative phase of the menstrual cycle. A cervical cannula or balloon catheter is placed within the cervix, and water-soluble contrast is injected under fluoroscopic guidance to delineate the uterine cavity and fallopian tubes.
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. Approximately 6–10 mL of contrast is sufficient to opacify the uterine cavity and tubes.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Uterine tenaculum (if required)
- Leech–Wilkinson cannula
- Rubin cannula
- Balloon HSG catheter
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Gentle injection of contrast is recommended to avoid uterine spasm or intravasation. Pregnancy and active pelvic infection must be excluded prior to the procedure.
Related Conditions
Differential diagnoses include septate uterus and bicornuate uterus. MRI or 3D ultrasound helps in accurately differentiating an arcuate uterus from clinically significant Müllerian anomalies.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.
No comments:
Post a Comment