Myometrial Folds (HSG)

Myometrial Folds (Hysterosalpingography)

Myometrial folds are a normal anatomical variant seen during hysterosalpingography, produced by transient uterine contractions or normal myometrial contouring. They appear as smooth, linear or curvilinear indentations along the uterine cavity margin and should not be mistaken for pathological filling defects. These folds typically resolve on delayed imaging or after uterine relaxation (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing myometrial folds. Smooth, shallow, linear indentations are seen along the uterine cavity margins without disruption of cavity symmetry or contour (arrows).

Findings: The uterine cavity is normal in size and configuration. Multiple smooth, symmetric indentations are noted along the cavity walls, consistent with myometrial folds. No fixed filling defects or cavity distortion are identified.

Conclusion: Imaging features are consistent with myometrial folds, representing a normal or transient physiological finding on HSG.

Patient Symptoms

Patients with myometrial folds are usually asymptomatic. The finding is incidental and commonly encountered during infertility evaluation. Mild pelvic discomfort may occur due to uterine contractions during the procedure.

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 contrast is injected slowly under fluoroscopic guidance. Delayed images may be obtained to confirm resolution of transient myometrial contractions.

Contrast Medium & Administration

A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Contrast injection is performed gently and incrementally 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

Total contrast volume typically ranges from 8–12 mL, with slow injection to allow optimal uterine cavity distension and to reduce myometrial spasm.

Safety Considerations

Pregnancy should be excluded prior to the procedure. Careful, slow injection minimizes uterine spasm and discomfort. Myometrial folds should be distinguished from pathological entities such as synechiae or polyps by their smooth contour and transient nature.

Related Conditions

Myometrial folds may mimic uterine synechiae, septa, or endometrial polyps. Repeat or delayed imaging and clinical correlation are essential for accurate interpretation.

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Declaration

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