Hematosalpinx (HSG)

Hematosalpinx – Hysterosalpingography

Hematosalpinx refers to accumulation of blood within the fallopian tube, most commonly associated with endometriosis, ectopic pregnancy, pelvic inflammatory disease, or post-procedural causes. On hysterosalpingography (HSG), hematosalpinx appears as a dilated fallopian tube with incomplete or absent peritoneal spill, often showing irregular or interrupted contrast column due to intraluminal blood products.

Fig-1

Fig. 1—Hysterosalpingogram showing hematosalpinx. The affected fallopian tube is dilated with irregular opacification and absence of free peritoneal spill (arrow).

Findings: The uterine cavity is normal in size and contour. One fallopian tube shows fusiform dilatation with interrupted or irregular contrast filling. The distal end appears obstructed with no free intraperitoneal spill, consistent with retained blood within the tube.

Conclusion: Hysterosalpingographic features are suggestive of hematosalpinx.

Patient Symptoms

Patients may present with infertility, chronic pelvic pain, dysmenorrhea, history of endometriosis, or prior pelvic infection. Acute symptoms are uncommon unless associated with recent hemorrhage.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. Gentle contrast injection is essential to avoid rupture of a distended tube.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is placed in the lithotomy position, and 5–8 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

Excessive injection pressure should be avoided due to risk of tubal rupture. HSG is contraindicated in suspected ectopic pregnancy or active pelvic infection.

Related Conditions

Differential diagnoses include hydrosalpinx, pyosalpinx, tubo-ovarian abscess, salpingitis isthmica nodosa, and tubal endometriosis. Correlation with ultrasound or MRI may aid diagnosis.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.