Septate Uterus (HSG)

Septate Uterus (Hysterosalpingography)

A septate uterus is a congenital Müllerian duct anomaly resulting from incomplete resorption of the midline septum after fusion of the Müllerian ducts. On hysterosalpingography, it is characterized by a single external uterine contour with a persistent midline septum dividing the endometrial cavity partially or completely. This anomaly is clinically significant due to its strong association with infertility, recurrent pregnancy loss, and adverse obstetric outcomes (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating a septate uterus. A persistent midline septum divides the uterine cavity into two symmetric endometrial channels with a normal external fundal contour (arrows).

Findings: The uterine cavity is divided by a central septum extending from the fundus toward the cervix. Both hemicavities are symmetric with smooth margins. The external uterine contour is presumed normal on HSG.

Conclusion: Imaging findings are consistent with a septate uterus. Further evaluation with 3D ultrasound or MRI is recommended to assess fundal morphology and guide management.

Patient Symptoms

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

Procedure (Hysterosalpingography)

HSG 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 morphology 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 usually sufficient to opacify both hemicavities and fallopian tubes.

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 avoid uterine spasm and false interpretation. Pregnancy and active pelvic infection must be excluded prior to the procedure. HSG cannot reliably assess the external fundal contour; complementary imaging is recommended.

Related Conditions

Differential diagnoses include bicornuate uterus, arcuate uterus, uterus didelphys, and transient double uterine contour due to myometrial spasm. MRI or 3D ultrasound is essential for definitive classification.

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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.