Septate with tubal blockage (HSG)

Septate Uterus with Tubal Blockage (Hysterosalpingography)

A septate uterus with associated tubal blockage represents a combined uterine cavity anomaly and tubal factor infertility. The septate uterus results from incomplete resorption of the Müllerian duct septum, while tubal obstruction may be congenital, inflammatory, or secondary to pelvic pathology. On hysterosalpingography, a midline septum divides the uterine cavity, with absent or delayed opacification and spill from one or both fallopian tubes (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating a septate uterus with tubal blockage. A persistent midline septum divides the uterine cavity into two hemicavities. One fallopian tube shows opacification without free peritoneal spill, consistent with tubal obstruction, while the contralateral tube may be patent or similarly blocked (arrows).

Findings: The uterine cavity is divided by a central septum with smooth margins. Opacification of the fallopian tube(s) shows abrupt cut-off and absence of peritoneal spill, indicating tubal obstruction.

Conclusion: Imaging findings are consistent with a septate uterus associated with tubal blockage.

Patient Symptoms

Patients commonly present with primary infertility, recurrent pregnancy loss, or failure to conceive despite ovulatory cycles. A history of pelvic inflammatory disease or prior pelvic surgery may be present in cases of tubal obstruction.

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 morphology and assess 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 contrast volume of 8–14 mL is administered gradually 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 essential to avoid uterine spasm and false-negative tubal filling. Pregnancy and active pelvic infection must be excluded prior to the study. Prolonged forceful injection should be avoided in suspected tubal blockage.

Related Conditions

Differential diagnoses include bicornuate uterus with tubal obstruction, complete septate uterus, pelvic inflammatory disease–related tubal occlusion, and post-surgical tubal scarring. MRI or 3D ultrasound may be used to confirm uterine morphology.

---

Declaration

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