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 a 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.
  • abdominal cramping
  • PV spotting
  • venous extravasation
  • pelvic infection
  • contrast reaction

Conditions which may be detected with HSG include:

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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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