Cervical stalked polyp (HSG)

Cervical Stalked Polyp – Hysterosalpingography

A cervical stalked polyp is a benign pedunculated growth arising from the endocervical mucosa. It is commonly associated with chronic inflammation, hormonal factors, or local irritation. On hysterosalpingography (HSG), a cervical stalked polyp appears as a smooth, well-defined intraluminal filling defect attached to the cervical wall by a narrow stalk, often surrounded by contrast (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing a cervical stalked polyp. A smooth, oval filling defect is seen within the cervical canal, attached to the wall by a narrow pedicle (arrow), with free contrast flow around it.

Findings: A solitary, well-circumscribed intraluminal filling defect is noted within the cervical canal. The lesion shows smooth margins and may change position slightly with patient movement or contrast flow. The uterine cavity and fallopian tubes are otherwise normal.

Conclusion: Hysterosalpingographic appearance is consistent with a cervical stalked polyp.

Patient Symptoms

Many patients are asymptomatic. Symptomatic patients may present with postcoital bleeding, intermenstrual spotting, vaginal discharge, or infertility.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. A cervical cannula or balloon catheter is placed carefully to avoid trauma to the polyp, and water-soluble contrast is injected under fluoroscopic guidance.

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 5–8 mL of contrast is injected slowly.

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

Gentle cannulation and contrast injection are essential to avoid bleeding from the polyp. Pregnancy and active pelvic infection must be excluded prior to the procedure.

Related Conditions

Differential diagnoses include endometrial polyp prolapsing into the cervix, submucosal fibroid, cervical cancer, and cervical diverticulum. Hysteroscopy allows definitive diagnosis and removal.

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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.