This document contains descriptions and radiographic images of various uterine and fallopian tube abnormalities that can be identified on hysterosalpingograms. These include normal anatomy as well as pathologies such as polyps, fibroids, adhesions, deformities, occlusions, and hydrosalpinges. Spot radiographs are shown demonstrating the characteristic appearances of these different conditions within the uterus and fallopian tubes.

1. HSG

2. (A) normal tubal patency, (B) endometrial polyp,
(C) submucosal leiomyomata, (D) intrauterine
synechiae, (E) hydrosalpinges, and (F) salpingitis
isthmica nodosum

3. • Air bubbles. (a) Spot
radiograph shows air
bubbles (arrow) in the
left side of the uterus

4. • ampullary portion of
the left fallopian tube,
a finding that is
consistent with a
hydrosalpinx. No
contrast material
spillage is seen on
the left side. The right
fallopian tube is
abruptly cut off

5. • Arcuate uterus in 30-
year-old woman.
Hysterosalpingogram
with normal findings
shows smooth
concave indentation
of uterine fundus

6. • Bicornuate uterus.
Spot radiograph
shows two markedly
splayed uterine horns.
The fallopian tubes
are not visualized at
this imaging stage

7. • large leiomyoma
distorting the
endometrial cavity as
it drapes over a mass
in the left
myometrium.

8. • Endometrial
adhesions.
Hysterosalpingogram
reveals irregular filling
defects in the
endometrium (arrows)
representing
adhesions.

9. • Endometrial polyp.
Anteroposterior (left)
and oblique (right)
hysterosalpingograms
demonstrate a
pedunculated filling
defect within the
uterine cavity

10. • HysteroSalpingogram

13. • large leiomyoma
distorting the
endometrial cavity as
it drapes over a mass
in the left
myometrium.

14. • left-sided
hydrosalpinx are also
noted. Amorphous
calcifications
(arrowheads) are
again seen on the
right side of the
pelvis.

15. • isthmic obstruction of
the left fallopian tube
just proximal to the
calcification. There is
obstruction in the
interstitial part of the
tube on the right side.
The endometrial
cavity shows
irregularity.

16. • Leiomyomas. (a) Spot
radiograph obtained
during the early filling
stage shows a well-
defined filling defect
(arrow) in the fundus

17. • open-sided speculum,
tenaculum, sponge
stick, antiseptic,
contrast medium, and
an acorn (Cohen)
cannula (A) or a
balloon-tip catheter (B

18. • Septate and arcuate
uterus. Spot
radiograph
demonstrates a
depression of the
uterine fundus, a
finding that may
represent a short
septum or an arcuate
deformity.

19. • Peritubal adhesions.
Spot radiograph
demonstrates a round
collection of contrast
material adjacent to
the left fallopian tube

20. • Spot radiograph
clearly depicts the
interstitial, isthmic,
and ampullary
portions of both
fallopian tubes

21. • Spot radiograph
obtained during the
early filling stage of
the uterus. Small
filling defects are best
seen at this stage.

22. • Spot radiograph
shows intraperitoneal
contrast material
spillage from the
fallopian tubes. In this
case, the spillage
outlines the convexity
of the uterine fundus (

23. • Spot radiograph
shows irregularity of
the uterine contour
with small
outpouchings of
contrast material,
findings that
represent diffuse
adenomyosis

24. • Submucosal fibroids.
Oblique (left) and
anteroposterior (right)
hysterosalpingograms
demonstrate smooth
filling defects
distorting the uterine
cavity and
representing
submucosal fibroids

25. • Synechiae. (a) Spot
radiograph shows a
central oval filling
defect within the
uterus, a finding that
represents a
synechia.

26. • synechie Spot
radiograph obtained
in a different patient
demonstrates a short
linear defect (arrow)
along the inferior left
side near the uterine
isthmus.

27. tb isthmic obstruction of both fallopian tubes. The tubes appear rigid
“pipe-stem” and are beaded. There is a lucent filling defect in the lower
uterine segment suggestive of adhesion

28. TB occlusion of bilateral tubes in the ampullary region with multiple
diverticula bilaterallysmall arrows The thick arrow indicates terminal
hydrosalpinx.

29. • Tubal occlusion. (a)
Spot radiograph
demonstrates abrupt
cutoff of the left
fallopian tube

30. • Unicornuate uterus.
Spot radiograph
demonstrates a single
uterine horn with an
irregular medial
contour. A single
fallopian tube is also
visualized

31. • uterine incision from a
cesarean section
(arrows) in the typical
location

32. • Dramatic
extravasation of
contrast media is
seen in the
myometrial and
uterine veins