Bicornuate uterus (HSG)

Bicornuate Uterus (Hysterosalpingography)

Bicornuate uterus is a congenital Müllerian duct anomaly resulting from incomplete fusion of the paired Müllerian ducts. This leads to a uterus with two symmetric uterine horns and a deep fundal cleft. On hysterosalpingography, the uterine cavity appears divided into two widely separated hemicavities that communicate at the level of the cervix, giving a characteristic heart-shaped configuration (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating a bicornuate uterus. Two symmetric uterine cavities are seen, widely divergent at the fundus with a deep fundal cleft (arrows). Both hemicavities communicate with the cervical canal.

Findings: The uterine cavity is divided into two well-formed horns with smooth margins. The fundal indentation is deep and broad, consistent with a bicornuate configuration. Fallopian tubes may be seen arising from each horn with free or delayed peritoneal spill depending on tubal patency.

Conclusion: Hysterosalpingographic features are consistent with a bicornuate uterus.

Patient Symptoms

Many patients are asymptomatic. Others may present with primary or secondary infertility, recurrent pregnancy loss, preterm labor, or malpresentation during pregnancy.

Procedure (Hysterosalpingography)

The study is performed in the early proliferative phase of the menstrual cycle. After aseptic preparation, a cervical cannula or balloon catheter is inserted. Water-soluble contrast is injected slowly under fluoroscopic guidance to evaluate uterine morphology and tubal patency.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is commonly used. The patient is positioned in the lithotomy position. Approximately 8–12 mL of contrast is administered gradually.

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 contrast injection is essential to minimize patient discomfort and reduce the risk of intravasation. Pregnancy and active pelvic infection must be excluded prior to the procedure.

Related Conditions

Differential diagnoses include septate uterus, didelphys uterus, and arcuate uterus. Correlation with 3D ultrasound or MRI is helpful to assess the external uterine contour and confirm the diagnosis.

---

Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.