Hysterosalpingogram

Changed by Prashant Mudgal, 17 Sep 2014

Updates to Article Attributes

Body was changed:

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

Technique

  • 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 
    • if there is any uncertainty about the patient’s pregnancy status, a bHCG is warranted prior to commencing.
  • after an antiseptic clean 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 postivepositive 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 remain 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.

Contraindications

  • pregnancy
  • active pelvic infection
  • recent uterine or tubal surgery

Complications

Common but self limiting
  • abdominal cramping
  • PV spotting
Rare but serious
  • pelvic infection
  • contrast reaction

Detectable pathology 

Conditions which may be detected with HSG include:

Uterine
Tubal
  • -<p>A <strong>hysterosalpingogram</strong> (<strong>HSG</strong>) is a fluoroscopic examination of the <a href="/articles/uterus" title="Uterus">uterus </a>and the <a href="/articles/uterine-tube" title="Fallopian tube">Fallopian tubes</a>, most commonly used in the investigation of infertility or recurrent spontaneous abortions. </p><h4>Technique</h4><ul>
  • -<li>the procedure should be performed during the proliferative phase of the patient’s menstrual cycle (days 6-12), when the endometrium is thinnest 
  • -<ul>
  • +<p><strong>Hysterosalpingogram</strong> (<strong>HSG</strong>) is a fluoroscopic examination of the <a href="/articles/uterus">uterus </a>and the <a href="/articles/uterine-tube">Fallopian tubes</a>, most commonly used in the investigation of infertility or recurrent spontaneous abortions.</p><h4>Technique</h4><ul>
  • +<li>the procedure should be performed during the proliferative phase of the patient’s menstrual cycle (days 6-12), when the endometrium is thinnest <ul>
  • -</li>
  • -<li>if there is any uncertainty about the patient’s pregnancy status, a bHCG is warranted prior to commencing.</li>
  • +</li>
  • +<li>if there is any uncertainty about the patient’s pregnancy status, a bHCG is warranted prior to commencing.</li>
  • -</li>
  • -<li>after an antiseptic clean 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.</li>
  • -<li>catheterisation of the cervix is then performed ; the type of device used depends on local practice preferences
  • -<ul>
  • -<li>e.g.  6 Fr Foley catheter with balloon inflation, or </li>
  • -<li>any one of a range of available HSG catheters or metal cannulas <sup>3</sup>.</li>
  • +</li>
  • +<li>after an antiseptic clean 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.</li>
  • +<li>catheterisation of the cervix is then performed ; the type of device used depends on local practice preferences<ul>
  • +<li>e.g.  6 Fr Foley catheter with balloon inflation, or</li>
  • +<li>any one of a range of available HSG catheters or metal cannulas <sup>3</sup>.</li>
  • -</li>
  • -<li>whatever the device, it should be primed with contrast prior to commencing to avoid the introduction of gas bubbles which may provide a false postive appearance of a filling defect.</li>
  • -<li>water soluble iodinated contrast is subsequently injected slowly under fluoroscopic guidance.</li>
  • -<li>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 remain controversial however <sup>8</sup>.</li>
  • -<li>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.</li>
  • +</li>
  • +<li>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.</li>
  • +<li>water soluble iodinated contrast is subsequently injected slowly under fluoroscopic guidance.</li>
  • +<li>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 remain controversial however <sup>8</sup>.</li>
  • +<li>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.</li>
  • -<li>pregnancy</li>
  • -<li>active pelvic infection</li>
  • -<li>recent uterine or tubal surgery</li>
  • +<li>pregnancy</li>
  • +<li>active pelvic infection</li>
  • +<li>recent uterine or tubal surgery</li>
  • -<li>abdominal cramping</li>
  • -<li>PV spotting</li>
  • +<li>abdominal cramping</li>
  • +<li>PV spotting</li>
  • -<li>pelvic infection</li>
  • -<li>contrast reaction</li>
  • +<li>pelvic infection</li>
  • +<li>contrast reaction</li>
  • -<li><a href="/articles/mullerian-duct-anomaly-classification" title="Müllerian duct anomalies">uterine congenital anomalies</a></li>
  • -<li>submucosal <a href="/articles/uterine-leiomyoma" title="Uterine fibroids">uterine fibroids</a>
  • -</li>
  • -<li><a href="/articles/malignant-neoplasms-involving-the-uterus" title="Uterine malignancy">uterine malignancy</a></li>
  • -<li><a href="/articles/adenomyosis-of-the-uterus" title="Adenomyosis of the uterus">adenomyosis</a></li>
  • -<li><a href="/articles/asherman-syndrome" title="Intrauterine adhesions">intrauterine adhesions</a></li>
  • -<li><a href="/articles/endometrial-polyp" title="Endometrial polyp">uterine (endometrial) polyps</a></li>
  • +<li><a href="/articles/mullerian-duct-anomaly-classification">uterine congenital anomalies</a></li>
  • +<li>submucosal <a href="/articles/uterine-leiomyoma">uterine fibroids</a>
  • +</li>
  • +<li><a href="/articles/malignant-neoplasms-involving-the-uterus">uterine malignancy</a></li>
  • +<li><a href="/articles/adenomyosis-of-the-uterus">adenomyosis</a></li>
  • +<li><a href="/articles/asherman-syndrome">intrauterine adhesions</a></li>
  • +<li><a href="/articles/endometrial-polyp">uterine (endometrial) polyps</a></li>
  • -<li>
  • -<a href="/articles/obliteration-of-fallopian-tubes" title="obliteration of fallopian tubes">obliteration of fallopian tubes</a> : usually secondary to previous pelvic inflammation.  It must be differentiated from incomplete tubal opacification due to tubal spasm, or underfilling of the uterus with contrast <sup>2</sup>.</li>
  • -<li>
  • -<a href="/articles/tubal-polyps" title="tubal polyps">tubal polyps</a> <sup>6</sup>.</li>
  • -<li><a href="/articles/tubal-malignancy" title="tubal malignancy">tubal malignancy</a></li>
  • -<li><a href="/articles/hydrosalpinx" title="Hydrosalpinx">hydrosalpinx</a></li>
  • -<li>
  • -<a href="/articles/salpingitis-isthmica-nodosa-1" title="Salpingitis Isthmica Nodosa">salpingitis isthmica nodosa</a> (SIN) <sup>4</sup>.</li>
  • -<li>
  • -<a href="/articles/tubal-spasm" title="tubal spasm">tubal spasm</a> <sup>6</sup> : can be physiological</li>
  • +<li>
  • +<a href="/articles/obliteration-of-fallopian-tubes">obliteration of fallopian tubes</a> : usually secondary to previous pelvic inflammation.  It must be differentiated from incomplete tubal opacification due to tubal spasm, or underfilling of the uterus with contrast <sup>2</sup>.</li>
  • +<li>
  • +<a href="/articles/tubal-polyps">tubal polyps</a> <sup>6</sup>.</li>
  • +<li><a href="/articles/tubal-malignancy">tubal malignancy</a></li>
  • +<li><a href="/articles/hydrosalpinx">hydrosalpinx</a></li>
  • +<li>
  • +<a href="/articles/salpingitis-isthmica-nodosa-1">salpingitis isthmica nodosa</a> (SIN) <sup>4</sup>.</li>
  • +<li>
  • +<a href="/articles/tubal-spasm">tubal spasm</a> <sup>6</sup> : can be physiological</li>

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