Uterine Leiomyoma (Fibroid) (HSG)

Uterine Leiomyoma (Fibroid) – Hysterosalpingography

Uterine leiomyomas, commonly known as fibroids, are benign smooth muscle tumors arising from the myometrium. They are the most common pelvic tumors in women of reproductive age. Depending on their location—submucosal, intramural, or subserosal—fibroids may distort the uterine cavity and interfere with fertility. On hysterosalpingography (HSG), submucosal and large intramural fibroids are best demonstrated by characteristic filling defects within the contrast-opacified uterine cavity (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram showing uterine leiomyoma. One or more well-defined, smooth or lobulated filling defects are seen projecting into the uterine cavity (arrows), consistent with submucosal fibroids.

Findings: The uterine cavity shows one or multiple rounded filling defects with smooth margins. The cavity may appear enlarged or distorted depending on fibroid size and location. Fallopian tubes may be normal or show secondary distortion or delayed spill.

Conclusion: Hysterosalpingographic features are suggestive of uterine leiomyoma (fibroid), likely submucosal or intramural with cavity distortion.

Patient Symptoms

Patients may present with menorrhagia, dysmenorrhea, pelvic pain, infertility, recurrent pregnancy loss, or pressure symptoms. Some fibroids are incidentally detected in asymptomatic patients during infertility workup.

Procedure (Hysterosalpingography)

The examination is performed in the early proliferative phase of the menstrual cycle. A cervical cannula or balloon catheter is introduced into the cervix, and water-soluble contrast is injected under fluoroscopic control to outline the uterine cavity and assess tubal patency.

Contrast Medium & Administration

A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Typically 6–10 mL of contrast is sufficient, though a slightly larger volume may be required in an enlarged uterine cavity.

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 pain, uterine spasm, or intravasation. Pregnancy and active pelvic infection must be excluded. HSG does not assess subserosal fibroids reliably.

Related Conditions

Differential diagnoses include endometrial polyps, intrauterine adhesions, and adenomyosis. Transvaginal ultrasound, saline infusion sonohysterography, or MRI provides superior characterization of fibroid number, size, and location.

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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.