Cervical synechiae (HSG)

Cervical Synechiae – Hysterosalpingography

Cervical synechiae refer to fibrous adhesions within the cervical canal resulting in partial narrowing or irregularity of the canal. They are usually acquired and commonly follow cervical instrumentation, surgery, infection, radiotherapy, or postpartum trauma. On hysterosalpingography (HSG), cervical synechiae appear as thin linear or band-like filling defects traversing the cervical canal, often causing irregular contrast flow or partial obstruction (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating cervical synechiae. Thin linear filling defects are seen crossing the cervical canal with irregular contrast passage (arrows).

Findings: The cervical canal shows irregular narrowing with fine contrast-negative bands representing adhesions. Contrast passage into the uterine cavity may be delayed but is usually achievable. The uterine cavity and fallopian tubes are often normal.

Conclusion: Hysterosalpingographic features are consistent with cervical synechiae.

Patient Symptoms

Patients may be asymptomatic or present with infertility, dysmenorrhea, hypomenorrhea, post-procedural difficulty in cervical access, or pelvic pain.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. Cannulation may be mildly difficult. A fine cannula or balloon catheter is preferred, and contrast is injected slowly 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. A small volume (4–7 mL) is usually sufficient.

Instruments Used

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

Safety Considerations

Gentle cannulation and low-pressure contrast injection are essential to avoid cervical trauma or creation of a false passage. Pregnancy and active pelvic infection must be excluded prior to the procedure.

Related Conditions

Differential diagnoses include cervical stenosis, cervical diverticulum, post-radiation fibrosis, and severe intrauterine adhesions extending into the cervix. Hysteroscopy provides definitive diagnosis and treatment.

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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.