Double Uterine Contour (Hysterosalpingography)
A double uterine contour on hysterosalpingography refers to the appearance of two parallel outlines of the uterine cavity caused by transient myometrial contraction, uterine spasm, or differential filling of the endometrial cavity. This is a functional and temporary phenomenon and should not be confused with congenital uterine anomalies such as septate or bicornuate uterus. Recognition of this finding is important to avoid overdiagnosis (Fig. 1).
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| Fig-1 |
Findings: The uterine cavity demonstrates smooth, parallel inner and outer contours without fixed indentation or cavity duplication. Delayed images show resolution of the double outline.
Conclusion: Imaging findings are consistent with a transient double uterine contour related to myometrial spasm, with no evidence of congenital uterine anomaly.
Patient Symptoms
Patients are usually asymptomatic. The finding is most often incidental during infertility evaluation. Mild pelvic discomfort may occur during contrast injection due to uterine contraction.
Procedure (Hysterosalpingography)
The examination is performed in the early proliferative phase of the menstrual cycle. Under aseptic precautions, a cervical cannula or balloon catheter is introduced. Contrast is injected slowly under fluoroscopic guidance, and delayed images are obtained to assess resolution of uterine spasm.
Contrast Medium & Administration
A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used with the patient in the lithotomy position. Total contrast volume typically ranges from 8–12 mL, administered slowly to minimize uterine spasm.
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, low-pressure injection is essential to avoid uterine spasm and misinterpretation. Delayed imaging should be performed before diagnosing congenital uterine anomalies. Pregnancy and pelvic infection must be excluded prior to the study.
Related Conditions
Differential diagnoses include septate uterus, bicornuate uterus, arcuate uterus, intrauterine synechiae, and focal adenomyosis. Resolution on delayed imaging helps differentiate double uterine contour from true anomalies.
Declaration
This case is presented for educational purposes only. Patient identity has been anonymized, and no personally identifiable information is disclosed.
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