Normal spill (HSG)

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.

Fig-1

Fig. 1—Hysterosalpingogram showing bilateral free peritoneal spill. Both fallopian tubes opacify completely and contrast flows freely into the peritoneal cavity (arrows).

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.

Tubal Fistula (HSG)

Left Tubal Fistula – Hysterosalpingography

Left tubal fistula represents an abnormal communication between the fallopian tube and an adjacent pelvic structure, allowing contrast to leak from the tubal lumen. On hysterosalpingography (HSG), features include extravasation of contrast outside the fallopian tube, irregular tubal outline, and possible distal obstruction.

Fig-1

Fig. 1—Hysterosalpingogram showing left tubal fistula. Contrast extravasation is seen outside the tubal lumen (arrows).

Findings: The affected fallopian tube may appear irregular, dilated proximally, and obstructed distally. Extravasation of contrast indicates abnormal communication with surrounding pelvic structures.

Conclusion: Hysterosalpingographic features are consistent with a left tubal fistula.

Patient Symptoms

Patients may present with infertility, chronic pelvic pain, or history of pelvic infection, surgery, or trauma. Recurrent infections or unusual discharge may also be reported.

Procedure (Hysterosalpingography)

HSG is performed during the early proliferative phase. Gentle, low-pressure contrast injection is essential to avoid worsening the fistulous tract or causing tubal rupture.

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 lithotomy and 5–8 mL of contrast is injected slowly under fluoroscopy.

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 excessive injection pressure to prevent worsening extravasation or tubal rupture. Active pelvic infection is a contraindication.

Related Conditions

Differential diagnoses include hydrosalpinx, pyosalpinx, tuberculous salpingitis, post-surgical tubal injury, or tubo-ovarian adhesions. Correlation with ultrasound, MRI, and microbiological tests is recommended.

---

Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.