Unilateral Cornual block (HSG)

Unilateral Cornual Block – Hysterosalpingography

Unilateral cornual block refers to obstruction at the uterine end (cornua) of one fallopian tube, preventing passage of contrast into that tube. It may be due to transient causes such as tubal spasm or mucus plugging, or true pathology including inflammation, fibrosis, endometriosis, or previous infection. On hysterosalpingography (HSG), the affected side shows non-opacification of the fallopian tube with a normal appearance of the opposite tube (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing unilateral cornual block. One fallopian tube fails to opacify beyond the uterine cornua, while the contralateral tube shows normal filling and free peritoneal spill (arrows).

Findings: The uterine cavity is normal in shape and size. Contrast fills one fallopian tube with free peritoneal spill, while the opposite tube shows abrupt termination at the cornual region with no distal opacification.

Conclusion: Hysterosalpingographic findings are consistent with a unilateral cornual block. Tubal spasm should be considered.

Patient Symptoms

Patients may be asymptomatic or present with primary or secondary infertility. Unilateral cornual block may still allow conception if the opposite tube is patent.

Procedure (Hysterosalpingography)

The examination is performed during the early proliferative phase of the menstrual cycle. If unilateral non-filling is observed, delayed images or gentle repeat injection may help differentiate true block from transient cornual spasm.

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 injected slowly under fluoroscopic guidance.

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

Forceful injection should be avoided to prevent tubal rupture or false passage. Pregnancy and active pelvic infection must be excluded. Apparent cornual block should always be interpreted with caution.

Related Conditions

Differential diagnoses include bilateral cornual block, tubal spasm, proximal tubal occlusion due to pelvic inflammatory disease, genital tuberculosis, and endometriosis. Selective salpingography or hysteroscopy may help confirm true obstruction.

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Declaration

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