Hysterosalpingography (HSG)

Normal Hysterosalpingography (HSG)

Hysterosalpingography is a fluoroscopic examination performed to evaluate the uterine cavity and fallopian tube patency, most commonly in the assessment of infertility. A normal HSG demonstrates a smooth, triangular uterine cavity with regular contours, symmetric cornua, and free bilateral peritoneal spill of contrast without evidence of obstruction or filling defects (Fig. 1).

Fig-1

Fig. 1—Normal hysterosalpingogram. The uterine cavity shows a smooth triangular outline with symmetric cornual regions. Both fallopian tubes are opacified and demonstrate free intraperitoneal spill of contrast (arrows).

Findings: The uterine cavity is normal in size and shape with smooth margins. Both fallopian tubes are visualized throughout their length with free bilateral peritoneal spill of contrast. No filling defects, strictures, or loculated spill are seen.

Conclusion:Normal hysterosalpingography with a normal uterine cavity and bilaterally patent fallopian tubes.

Patient Symptoms

Patients are commonly asymptomatic and referred for infertility evaluation. Some may report dysmenorrhea or menstrual irregularities without structural abnormality.

Procedure (Hysterosalpingography)

The examination is performed in the early proliferative phase of the menstrual cycle (day 7–10). Under aseptic precautions, a cervical cannula is introduced and water-soluble contrast is injected slowly under fluoroscopic guidance to evaluate the uterine cavity and fallopian tubes.

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. Contrast is injected slowly to allow sequential assessment of uterine filling, tubal opacification, and peritoneal spill.

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

Contrast volume typically ranges from 8–12 mL. Initial uterine filling is achieved with 4–6 mL, followed by gradual injection for tubal and peritoneal evaluation.

Safety Considerations

Pregnancy must be excluded prior to the study. A history of pelvic infection or contrast allergy should be reviewed. Mild pelvic cramping is common and self-limiting.

Related Conditions

Normal HSG serves as the reference standard for comparison with congenital uterine anomalies, tubal obstruction, uterine synechiae, post-surgical scars, and inflammatory conditions.

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Declaration

This case is presented for educational purposes only. No patient-identifiable information is disclosed, and ethical standards for anonymized imaging data are maintained.