Partial Septate Uterus (HSG)

Partial Septate Uterus (Hysterosalpingography)

A partial septate uterus is a congenital Müllerian duct anomaly resulting from incomplete resorption of the midline septum, in which the septum extends from the uterine fundus but does not reach the internal cervical os. On hysterosalpingography, it appears as a central fundal indentation dividing the uterine cavity into two symmetric compartments while maintaining a single external uterine contour. This condition is clinically significant due to its association with infertility and recurrent pregnancy loss (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating a partial septate uterus. A midline septum extends from the fundus into the uterine cavity but does not reach the internal os, creating two symmetric endometrial spaces (arrows).

Findings: The uterine cavity shows a central fundal septum of limited length with smooth margins. Both hemicavities are symmetric, and the cervix appears single and normal. Fallopian tubes are visualized bilaterally.

Conclusion: Imaging findings are consistent with a partial septate uterus. Further evaluation with 3D ultrasound or MRI is recommended for definitive classification and treatment planning.

Patient Symptoms

Patients may present with primary or secondary infertility, recurrent early pregnancy loss, or preterm delivery. Some individuals remain asymptomatic and are diagnosed incidentally during infertility evaluation.

Procedure (Hysterosalpingography)

Hysterosalpingography is performed in the early proliferative phase of the menstrual cycle. Under aseptic precautions, a cervical cannula or balloon catheter is placed. Contrast is injected slowly under fluoroscopic guidance to delineate uterine cavity anatomy and tubal patency.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used with the patient in the lithotomy position. A total volume of 8–12 mL is generally sufficient.

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 contrast injection is advised to minimize uterine spasm and avoid false interpretation. Pregnancy and pelvic infection must be excluded prior to the study. HSG cannot assess the external uterine fundal contour; confirmatory imaging is essential.

Related Conditions

Differential diagnoses include complete septate uterus, bicornuate uterus, arcuate uterus, and transient double uterine contour. MRI or 3D ultrasound aids accurate differentiation.

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Declaration

This case is presented for educational purposes only. Patient identity has been anonymized, and no personally identifiable information is disclosed.