Intrauterine adhesions (Asherman syndrome) (HSG)

Intrauterine Adhesions (Asherman Syndrome) – Hysterosalpingography

Intrauterine adhesions, also known as Asherman syndrome, result from partial or complete obliteration of the uterine cavity due to fibrous scar tissue. They most commonly follow uterine instrumentation such as dilatation and curettage, postpartum curettage, or uterine surgery. On hysterosalpingography (HSG), the condition is characterized by irregular, angular filling defects, non-opacified segments of the uterine cavity, and reduced uterine cavity volume (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating intrauterine adhesions. Irregular linear and angular filling defects are seen within the uterine cavity with areas of non-opacification and cavity distortion (arrows).

Findings: The uterine cavity appears partially obliterated with irregular outlines and reduced volume. Contrast outlines fibrous bands bridging opposing walls of the uterus. Tubal filling may be reduced or absent depending on the severity of adhesions.

Conclusion: Hysterosalpingographic findings are consistent with intrauterine adhesions (Asherman syndrome).

Patient Symptoms

Patients may present with secondary amenorrhea, hypomenorrhea, infertility, recurrent pregnancy loss, or cyclic pelvic pain due to outflow obstruction.

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 slowly under fluoroscopic guidance to assess the uterine cavity and 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. Injection should be slow and gentle, typically 4–8 mL, to avoid uterine perforation.

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

Contrast injection should be minimal and under low pressure due to the risk of uterine perforation. Pregnancy and active pelvic infection must be excluded. HSG may underestimate disease severity.

Related Conditions

Differential diagnoses include endometrial polyps, submucosal fibroids, and congenital uterine anomalies. Hysteroscopy is the gold standard for definitive diagnosis and treatment planning.

---

Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.