Unilateral Tubal Spill – Hysterosalpingography
Unilateral tubal spill refers to opacification and free peritoneal spill of contrast from one fallopian tube only on hysterosalpingography (HSG), while the contralateral tube shows no spill due to obstruction, spasm, or prior pathology.
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Findings: One fallopian tube is patent with normal caliber and free intraperitoneal spill. The contralateral tube shows non-opacification or distal cut-off, suggestive of obstruction or spasm.
Conclusion: HSG findings are consistent with unilateral tubal patency.
Patient Symptoms
Patients may present with primary or secondary infertility. Many remain asymptomatic, while some may have a history of pelvic inflammatory disease or prior pelvic surgery.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase of the menstrual cycle. Gradual contrast injection helps differentiate true tubal 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. Approximately 5–8 mL is injected slowly under fluoroscopic guidance.
Instruments Used
- Sterile vaginal speculum
- Leech–Wilkinson or Rubin cannula
- Balloon HSG catheter
- 10–20 mL Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Excessive injection pressure should be avoided to prevent pain and false-negative results. Active pelvic infection is a contraindication.
Related Conditions
Unilateral spill should be differentiated from cornual spasm, partial tubal obstruction, hydrosalpinx, or post-surgical tubal changes. Delayed images or antispasmodic agents may help clarification.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been maintained.
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