Normal Tubal Spill – Hysterosalpingography
Normal spill indicates patent fallopian tubes with unobstructed passage of contrast into the peritoneal cavity. On hysterosalpingography (HSG), both tubes opacify completely with smooth contours, and contrast disperses freely into the peritoneal cavity bilaterally.
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Findings: Uterine cavity is normal in size, shape, and contour. Both fallopian tubes demonstrate smooth outlines and patency with no evidence of obstruction or loculated contrast.
Conclusion: HSG findings indicate normal tubal patency with free peritoneal spill.
Patient Symptoms
Usually performed in patients undergoing infertility work-up. Patients may be asymptomatic or have mild menstrual irregularities.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase. Gentle contrast injection is done to visualize the uterine cavity and fallopian tubes under fluoroscopy.
Contrast Medium & Administration
Water-soluble iodinated contrast such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Approximately 5–8 mL is injected slowly in the lithotomy position 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
Avoid high injection pressure to prevent tubal spasm or intravasation. Active pelvic infection is a contraindication.
Related Conditions
Normal spill differentiates patent tubes from distal obstruction, hydrosalpinx, loculated spill, or tubal adhesions. Correlation with clinical history and ultrasound may be advised.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.
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