Unicornuate Uterus (HSG)

Unicornuate Uterus (Hysterosalpingography)

Unicornuate uterus is a congenital Müllerian duct anomaly resulting from complete or partial failure of development of one Müllerian duct. This leads to formation of a single, laterally placed uterine cavity, often associated with a contralateral rudimentary horn. On hysterosalpingography, a single elongated and curved uterine cavity is visualized, typically described as banana-shaped, with only one fallopian tube opacified (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram demonstrating a unicornuate uterus. A single, narrow, elongated uterine cavity is seen deviated to one side, giving a curved or banana-shaped appearance (arrows). Only one fallopian tube is visualized with contrast spill.

Findings: The uterine cavity is asymmetric and laterally placed with smooth margins. Only one fallopian tube is opacified with free intraperitoneal spill. The contralateral horn is absent or present as a non-communicating rudimentary horn, not visualized on HSG.

Conclusion: Hysterosalpingographic findings are consistent with a unicornuate uterus.

Patient Symptoms

Patients may present with infertility, recurrent pregnancy loss, preterm delivery, malpresentation, or ectopic pregnancy. Some individuals remain asymptomatic.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. After aseptic preparation, a cervical cannula or balloon catheter is placed. Water-soluble contrast is injected slowly under fluoroscopic guidance to evaluate uterine 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. The patient is positioned in the lithotomy position. Approximately 6–10 mL of contrast is administered gradually.

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

Contrast should be injected gently to avoid uterine perforation or intravasation. Pregnancy and active pelvic infection must be excluded prior to the procedure.

Related Conditions

Differential diagnoses include bicornuate uterus, septate uterus, and uterine didelphys. MRI or 3D ultrasound is recommended for evaluation of associated rudimentary horn and renal anomalies.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been maintained and no identifiable data is disclosed.