Tubal Polyps (HSG)

Tubal Polyp – Hysterosalpingography

Tubal polyp represents a benign intraluminal lesion of the fallopian tube, commonly arising from the mucosal folds. It may cause partial or intermittent tubal obstruction and is a recognized cause of infertility. On hysterosalpingography (HSG), a tubal polyp typically appears as a smooth, well-defined intraluminal filling defect within an otherwise opacified fallopian tube, with delayed or reduced peritoneal spill.

Fig-1

Fig. 1—Hysterosalpingogram demonstrating a tubal polyp. A smooth intraluminal filling defect is seen within the fallopian tube, surrounded by contrast, with mild delay in distal contrast passage (arrow).

Findings: The uterine cavity appears normal in size and contour. One fallopian tube shows a well-circumscribed intraluminal filling defect with preserved tubal outline. Partial contrast passage beyond the lesion is noted with reduced or delayed peritoneal spill.

Conclusion: Hysterosalpingographic features are suggestive of a tubal polyp.

Patient Symptoms

Patients may be asymptomatic or present with primary or secondary infertility. Some may report intermittent pelvic discomfort. Menstrual history is usually normal.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. Slow, controlled contrast injection helps in accurate visualization of intraluminal tubal abnormalities.

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, and 5–10 mL of contrast is injected gradually under fluoroscopic control.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Leech–Wilkinson cannula
• Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

Excessive injection pressure should be avoided to prevent tubal spasm or rupture. Active pelvic infection is a contraindication for HSG.

Related Conditions

Differential diagnoses include tubal mucus plugs, air bubbles, salpingitis isthmica nodosa, tubal adhesions, and early hydrosalpinx. Confirmation may require hysteroscopy, laparoscopy, or salpingoscopy.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been maintained.