HYSTEROSALPHINGOGRAPHY RADIOLOGY ANATOMY 1ST YEAR MBBS

1. HARINI.
M
1ST YEAR
MBBS
GKMC

2. HYSTEROSALPHINGOGRAPHY
It is a radiological procedure in which the contrast is injected into
the uterus to study the uterine tubes and the fallopian tube.

3. When can this procedure be performed ?
28 DAYS RULE
 Menstrual Cycle varies ,
generally 28 days.
 If the patient is to be exposed to
ionizing radiation for diagnostic
purposes and the patient is of
child bearing age ,postpone
exposure for 28 days from 1st
day of menstrual cycle to rule
out pregnancy.
10 DAYS RULE
 If patient to exposed to
ionizing radiation for
diagnostic purpose and the
patient is of child bearing age
, she should be booked in the
1st 10 days of the menstrual
cycle, when the conception is
unlikely to have occurred.

4. INDICATIONS
Not being able to
conceive after a long
year of trying.
INFERTILITY
Recurrent pregnancy loss, defined as 3
consecutive pregnancy losses prior to
20 weeks from the last menstrual period.
RECURRENT ABORTION
During tubal ligation, the
fallopian tube are cut, tied or
blocked to permanently
prevent pregnancy.
FOLLOWING TUBAL SURGERY
Tuberculosis, sub
mucous fibroids etc..
UTERINE & TUBAL
LESIONS
Migration of the IUD to the pelvic
and abdominal cavity or seen
following perforation of the
uterus.
MIGRATED IUCD
Includes Septa and adhesions as
in Asherman’s syndrome.
CONGENITAL OR ACQIRED
UTERINE ANOMALIES

5. CONTRAINDICTIONS
 ACTIVE PELVIC
SEPSIS
 SENSITITIVE TO CONTRAST
MEDIA
 PREGNANCY
 SEVERE RENAL OR
CARDIAC DISEASE
 WEEK PRIOR TO THE WEEK
OF ONSET OF
MENSTRUATION
 CERVICITIS

7. CONTRASTMEDIA

8. PREPARATIONS & PREMEDICATIONS
Ideal time of procedure: Between 8th & 10th day
of menstrual cycle.
 If patient is anxious – 5 to 10 mg of I.V diazepam 30 min before the
procedure.
 0.6mg atropine sulphate in 1ml Ampoule can given I.V 10-15 min
before starting the procedure.
 4 Hours of fasting prior to the procedure.
 Void the urine before procedure.

9. TECHNIQUES
1)Using Cannula
 Leech Wilkinson Cannula.
 Jercho Type.
 Spackman.
2)Using Foleys Catheter

10. CANNULAMETHOD
 The patient is placed in lithotomy position at the edge of the X-ray
table.
 A spectrum is introduced into the vagina and the anterior lip of the
cervix is held with tenaculum and gentle traction is applied.

11.  The Canula is inserted into
the cervical canal under
direct vision.
 The Spectrum is then
removed ,and the patient
moved to supine position.
 Under fluoroscopic
control,2ml of the contrast
media is injected to outline
uterine cavity.

12.  To prevent the leak from cervix, a downward traction should be kept on
the tenaculum an upward pressure to the canula.
 Disadvantage: Causes cervical trauma and bleeding.

13. NORMALHSG

14. FOLEY’SCATHETERMETHOD
 8F Foley’s Catheter is used.
 The cervix is exposed with a
vaginal speculum and
swabbed with an antiseptic
solution.
 The lumen of the catheter is
filled with contrast to prevent
air bubbles.

15.  The catheter is injected through the cervical
os using a cervical forceps to guide it when
the ballon lies within uterine cavity , it is
gently inflated with water (2-3ml)
 Before injection of contrast, the ballon is
pulled downwards against the internal os.
 The Spectrum is withdrawn, and catheter is
attached to syringe and contrast is injected.

17. FILMING
• As the tube begin to fill
• When Peritoneal spill has occurred.
• Maximum X-ray screening time must not exceed 30 sec.
• Only 3-4 spot exposures are permitted in order to
minimize radiation to gonads.

18. AFTERCARE
 It must be
ensured that
patient is in no
serious
discomfort
before she
leaves
 She must be
cautioned that there
may be mild
bleeding for 1-2
days.

19. 1)Pain may occur
 Using the vulsellum forceps.
 During insertion of canula.
 With tubal distension and distension of uterus.
 Generalized lower abdominal pain due to peritoneal irritation
by the contrast media.
2)Trauma to the uterus due to canula causing perforation.
3)Exacerbation of pelvic infection (0.25-3% infection rate after procedure)
COMPLICATIONS

20. ABNORMALFINDINGSINHSG
UTERINE
1.Uterine anomalies:
Unicornulate,Didelphys,Bicornu
ate,Septate,Arcuate.
2.Fibroid(Submucosal)
3.Adenomyosis
4.Endometrial polyp
5.Intrauterine
adhesions/synechiae
6.Endometrial TB
7.Cervical Incompetence
8.Uterine Myoma
TUBAL
1.Tubal block
2.Tubal Spasm
3.Tubal polyp
4.Hydrosalpinx
5.Salpingitis isthmic nodosum
6.Peritubular adhesions
7.TB salpingitis

21. CLINICALCORRELATION
1)UNICORNUATE UTERUS
 Rare genetic condition in which only one half
of a girls’s uterus formed.

22. 2)UTERUS DIDELPHYS
 Represents a uterine malformation where the uterus is
present as paired organ when the embryogenetic fusion of the
Mullerian duct fails to occur.

23. 3)BICORNUATE UTERUS
 Type of congenital uterine malformation or mullerian duct
anomaly in which the uterus appears to be heart-shaped.

24. @369avenger_2003