Hysterosalpingogram

Hysterosalpingogram (HSG) is a fluoroscopic examination of the uterus and the Fallopian tubes, most commonly used in the investigation of infertility or recurrent spontaneous abortions.

  • Infertility to assess uterine morphology and tubal patency.
  • pregnancy
  • active pelvic infection
  • recent uterine or tubal surgery
  • the procedure should be performed during the proliferative phase of the patient’s menstrual cycle (days 6-12), when the endometrium is thinnest 
    • this improves visualisation of the uterine cavity, and also minimises the possibility that the patient may be pregnant 1
    • if there is any uncertainty about the patient’s pregnancy status, a beta hCG is warranted prior to commencing.
  • after an antiseptic cleaning of the external genital area, a vaginal speculum is inserted with the patient in the lithotomy position; the cervix is cleaned with an aseptic solution.
  • catheterisation of the cervix is then performed; the type of device used depends on local practice preferences
    • e.g.  6 Fr Foley catheter with balloon inflation, or
    • any one of a range of available HSG catheters or metal cannulas 3.
  • whatever the device, it should be primed with contrast prior to commencing to avoid the introduction of gas bubbles which may provide a false positive appearance of a filling defect.
  • water soluble iodinated contrast is subsequently injected slowly under fluoroscopic guidance.
  • some radiologists use iodinated oil (Lipiodol) as contrast when the indication is for lack of fertility. Some authors report increased fertility after its use. This remains controversial however 8.
  • a typical fluoroscopic examination includes preliminary frontal view of the pelvis, as well as subsequent spot images that demonstrate uterine endometrial contour, filled fallopian tubes and bilateral intraperitoneal spill of contrast, to establish tubal patency.
Common but self limiting
  • abdominal cramping
  • PV spotting
  • venous extravasation
Rare but serious
  • pelvic infection
  • contrast reaction

Conditions which may be detected with HSG include:

Uterine
Tubal
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Article information

rID: 10938
Synonyms or Alternate Spellings:
  • Hysterosalpingography
  • HSG
  • Hysterosalpingogram (HSG)

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Cases and figures

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    Normal hysterosal...
    Case 1: normal HSG
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    Case 2: Normal hysterosalpingogram
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    Case 3: showing a septate uterus mimicking didelphys uterus
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    Case 4: showing a sub mucosal uterine leiomyoma
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    Case 5: intra-uterine adhesions
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    Case 6: showing hydrosalpinx
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    Case 7: showing intra-uterine adhesions
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    Case 8
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    Late filling.
    Case 9: unilateral cornual block
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    Late filling.
    Case 10: bilateral cornual block
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    Bicornuate uterus
    Case 11: showing a bicornuate uterus
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