Hysterosalpingography is a radiological procedure that involves injecting radiopaque dye into the cervix and uterine cavity to visualize the uterus and fallopian tubes. It is used to evaluate infertility, detect uterine anomalies, and diagnose intrauterine lesions or adhesions. The procedure is usually performed postmenstrually to avoid disturbing early pregnancy or causing false positives. Two types of dye are commonly used: oily and water-soluble. The films are analyzed to assess the shape and patency of the uterine cavities and fallopian tubes. While HSG can detect tubal obstructions, laparoscopy provides a more accurate evaluation of tubal patency and allows for diagnosis and treatment of other
2. Definition
It’s a radiological procedure in which a
radio opaque dye is injected into the
endocervical canal ,the endometrial
cavity (hytero) and the lumen of the
fallopian tube (salpingo)
4. Technique
Timing
Postmenstrual
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why
1-Avoid disturbing an early pregnancy
2--Premenstrual HSG may cause false –positive
findings of tubal obstruction because of thickened
premenstrual endometrium may occlude the tubes
3-Avoid the risk of endometriosis
4-Minimize the possibility of extravasation (excessive
congestion )
6. Types of dyes
Two types are available: (a) oily dye "lipidol" l
Advantages:
.1
1. higher pregnancy rate after it:
• -it may by pass tubal obstruction by dislodgment
of mucus plugs ,fine adhesion or small polyps
• -enhancing ciliary movements
• -has bacteriostatic effect
2. good delineation of structure (dense dye)
3. second film is more conclusive (done after 24 h)
Disadvantages:
1.oil granuloma
2.oil embolism
3.iodine sensitivity
7. (b)Water soluble dye (urographin)
Advantages:
1.can show mucosal folds specially in the fallopian tubes
(endosalingeal plicae)
Which is a good prognostic factor after tubal
surgery, also the uterine mucosa can be
delineated with it.
2. can diagnose fine lesions e.g small polypi,
adhesions or masses.
Disadvantages:
1.less conclusive second film as the intestine has little time
to smear the dye.
2.less delineation of structures
3.More painful
8. Technique
precautions
Antispasmodics should be prescribed piror
to the procedure to reduce uterine
contractility
Through vaginal examination
*Grasping the anterior lip of the cervix by a
volsellum.
*Sounding
introduction of the nozzle of the HSG
cannula into the lower part of the cervical
canal.
9. Alternative methods of injection include:
*Vaccum uterine cannula which doesn't need volesellum
and so it is less painful
*Balloon catheter especially if the cervix is
patoulous.However, it masks the cervical canal and the
lower part of the uterine cavity
The vaginal speculum should be removed before injection
to visualize the cervical canal properly.
Amount of the dye is variable from 6 to 10cc.
12. (a) Endocervical canal
- is it visualized or not :sometimes it is masked by the
shadow of the vaginal speculum
-Linning : may be smooth or irregular due to the presence
of the prominent mucosal folds (plicae palmatae)
-Internal os: normally a constriction is seen at the junction
with the endometrium shadow
-Filling defects : may be a small polyp,aband of adhesions
or air bubbles
14. C-Fallopian tubes
Normal variations : FT are mobile organs . they may take
different shapes or positions .sometimes a part of FT
is hidden by the uterine shadow . in such cases a
lateral view is indicated .
Segemental loss of the continuity of the FT is a normal
finding because of the frequent segmental tubal
contractions and relaxation .
15. Comment on the FT
Visualized or not :
Cause of non visualized tube ??????
Insufficient dye: rounded corneal ends
Tubal spasm : excluded by giving the patient antispasmodic prior
to HSG.
Tubal obstruction: may be in lumen , in the wall outside the tube .
Comment on the extent of visualization of the FT normally well
seen till the fimbrea
Distended or not ?
A distended distal part of FT at the 1st film raises the suspension
of hydrosalpinx
.Confirmation by 2nd film
16. Presence of other shadows
1- Calcified lymph node .
2-immediate spell (due to excessive dye)
3- artifacts due to leakage of the dye on the x-ray
table .
4- calcified leiomyoma or dermoid cyst .
5-Genital TB
17. A-Second film
Timing :
Its done after 24 h from the injection of lipiodol or less than 1/2 h
from water soluble dye .
Comment of the 2nd film
1- is the dye visualized or not ?
Non visualization may be due to insufficient dye , proximal tubal
obstruction or tubal spasm .
2-Is there localization or not ?
Localization may be :
A-Tubular in shape with regular outlines >>mostly hydrosalpnix
B-Irregular in shape with hazy borders >>mostly adhesions .
C- Beaded (oil water appearance) >>> mostly TB
18. Patency of the tubes can be
only diagnosed after a
normal 2nd film .
19. Diagnosis of TB from HSG :
1-Intravasation
2-Distended tubes with beading appearance .
3- Calcified tubes or lymph nodes
Intravasition (extravasation)
It’s the passage of the dye into the blood or lymph vessels . lymphatic
intravasation persist in the 2nd film as the lymphatic absorption is slower
than venous system .
Causes :
1-Tubal obstruction
2-Extensive intrauterine adhesions
3- Congested uterus
4- Premenstrual HSG
5- Recent uterine perforation
6- Undiagnosed pregnancy
1-Intravasation
2-Distended tubes with beading appearance .
3- Calcified tubes or lymph nodes
Intravasition (extravasation)
It’s the passage of the dye into the blood or lymph vessels . lymphatic
intravasation persist in the 2nd film as the lymphatic absorption is slower
than venous system .
Causes :
1-Tubal obstruction
2-Extensive intrauterine adhesions
3- Congested uterus
4- Premenstrual HSG
5- Recent uterine perforation
6- Undiagnosed pregnancy
20. Advantages of HSG over
insufflation :
1-It shows the site of obstruction in the tube
whether its unilateral or bilateral .
2-Diagnosis of pelvic and peritoneal adhesions .
3- Diagnosis of uterine abnormalities as
bicornaute uterus or submucous fibroid
4- It has a therapeutic effects.
21. Advantages of HSG over
laparoscopy?
1-Visualization of uterine cavity
2-Detect actual size of fallopian tube .
3-Less invasive &sheep
4-Therapeutic effect of lipidol
5-Enhancent of ciliary movement
6- Bacteriostatic
7- Displacement of fine mucous plug &adhesion .
22. Advantages of laparoscopy over
HSG?
1-Accurate diagnosis of tubal patency as HSG >>without
anathesia >>reflex spasm tube .
2-Detection peritubal adhesion lesion
3- Diagnosis of other pelvic lesion – endometriosis – 4-
PCO – pelvic adhesions .
5-Chance for therapeutic intervention :
A-PCO>>ovarian drilling
B- Adhesolysis >> adhesion in pelvis
