Sonoacademy : Normal Uterine Cavity with Bilateral Free Peritoneal Spill (HSG)

Friday, 2 January 2026

Normal Uterine Cavity with Bilateral Free Peritoneal Spill (HSG)

Normal Uterine Cavity with Bilateral Free Peritoneal Spill – Hysterosalpingography

HSG

A normal hysterosalpingogram demonstrates a normally shaped uterine cavity with smooth contours and symmetrical outlines. Both fallopian tubes are visualized in their entirety, and contrast flows freely into the peritoneal cavity on both sides, indicating bilateral tubal patency.

Fig-1

Fig. 1—Hysterosalpingogram showing a normal uterine cavity with smooth margins. Both fallopian tubes are fully opacified with free intraperitoneal spill of contrast bilaterally (arrows).

Findings: The uterine cavity is normal in size, shape, and contour. Both fallopian tubes show smooth outlines without narrowing or dilatation. Contrast freely disperses into the peritoneal cavity on both sides.

Conclusion: Normal hysterosalpingographic study with bilateral tubal patency.

Patient Symptoms

This finding is usually seen in asymptomatic patients undergoing infertility evaluation. No structural abnormality is demonstrated.

Procedure (Hysterosalpingography)

HSG is performed during the early proliferative phase of the menstrual cycle. Contrast is injected slowly under fluoroscopic guidance.

Contrast Medium & Administration

A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Approximately 5–8 mL of contrast is administered in the lithotomy position.

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 discomfort or contrast intravasation. Active pelvic infection is a contraindication.

Related Conditions

This appearance should be differentiated from delayed spill, loculated spill, unilateral spill, or tubal spasm. Adequate timing and gentle injection help confirm true tubal patency.