Endometrial polyp (HSG)

Endometrial Polyp – Hysterosalpingography

Endometrial polyps are localized overgrowths of endometrial tissue arising from the uterine lining. They may be sessile or pedunculated and can project into the uterine cavity, causing abnormal uterine bleeding or infertility. On hysterosalpingography (HSG), endometrial polyps are typically seen as well-defined, smooth filling defects within an otherwise normal uterine cavity (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing an endometrial polyp. A solitary, round to oval, smooth filling defect is seen within the uterine cavity (arrow), surrounded by contrast.

Findings: A well-circumscribed intraluminal filling defect with smooth margins is noted within the uterine cavity. The remainder of the cavity outline is normal. Fallopian tubes are usually normal with free peritoneal spill.

Conclusion: Hysterosalpingographic appearance is suggestive of an endometrial polyp.

Patient Symptoms

Patients may present with abnormal uterine bleeding, intermenstrual spotting, infertility, or recurrent pregnancy loss. Some endometrial polyps are asymptomatic and detected incidentally during infertility evaluation.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. A cervical cannula or balloon catheter is placed, and water-soluble contrast is injected under fluoroscopic guidance to outline the uterine cavity and assess tubal patency.

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. Typically 6–10 mL of contrast is sufficient for adequate cavity opacification.

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 injection of contrast is recommended to minimize uterine spasm and patient discomfort. Pregnancy and active pelvic infection must be excluded prior to the procedure. Small polyps may be missed on HSG.

Related Conditions

Differential diagnoses include submucosal fibroid, intrauterine adhesions, and focal adenomyosis. Saline infusion sonohysterography and hysteroscopy are more sensitive for 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.