Bilateral Cornual block (HSG)

Bilateral Cornual Block – Hysterosalpingography

Bilateral cornual block refers to obstruction at both uterotubal junctions (cornual regions), resulting in failure of contrast to enter either fallopian tube. The obstruction may be functional—most commonly due to bilateral tubal spasm or mucus plugging—or organic, secondary to fibrosis, infection (including genital tuberculosis), endometriosis, or prior uterine surgery. On hysterosalpingography (HSG), bilateral cornual block is characterized by opacification of the uterine cavity without visualization of either fallopian tube (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing bilateral cornual block. Contrast opacifies the uterine cavity but fails to progress beyond both cornual regions (arrows), with no tubal visualization or peritoneal spill.

Findings: The uterine cavity is normal in size and contour. Both cornual regions show abrupt termination of contrast with non-opacification of the fallopian tubes. No intraperitoneal spill is seen.

Conclusion: Hysterosalpingographic findings are consistent with bilateral cornual block.

Patient Symptoms

Patients usually present with primary or secondary infertility. Menstrual history is often normal. Bilateral cornual block is a significant cause of tubal factor infertility.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. When bilateral non-filling is seen, delayed images, gentle repeat injection, or antispasmodic administration may help differentiate transient tubal spasm from true organic obstruction.

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 injected slowly under fluoroscopic guidance.

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
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

High injection pressure should be avoided to prevent tubal rupture or intravasation. Apparent bilateral cornual block should be interpreted with caution, as bilateral tubal spasm is relatively common.

Related Conditions

Differential diagnoses include bilateral tubal spasm, proximal tubal block, genital tuberculosis, severe peritubal adhesions, and post-surgical fibrosis. Selective salpingography or laparoscopy may be required for confirmation.

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Declaration

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