Last revised by Mohammadtaghi Niknejad ◉ on 6 Dec 2022
Citation, DOI, disclosures and article data
Stanislavsky A, Niknejad M, Chieng R, et al. Hysterosalpingogram. Reference article, Radiopaedia.org (Accessed on 22 Mar 2023) https://doi.org/10.53347/rID-10938
3 Oct 2010, Alexandra Stanislavsky ◉
At the time the article was created Alexandra Stanislavsky had no recorded disclosures.View Alexandra Stanislavsky's current disclosures
6 Dec 2022, Mohammadtaghi Niknejad ◉
At the time the article was last revised Mohammadtaghi Niknejad had no financial relationships to ineligible companies to disclose.View Mohammadtaghi Niknejad's current disclosures
37 times, by 18 contributors - see full revision history and disclosures
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.
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- Infertility to assess uterine morphology and tubal patency.
- 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 visualization of the uterine cavity, and also minimizes 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.
- catheterization 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.
- Foley catheter has several technical disadvantages, such as difficulty in inserting the catheter in angulated or problematic cervix. Other conditions that increase the difficulty of Foley catheter insertion are: acute anteverted or retroverted uterus, cervical stenosis, highly positioned cervix due to pelvic adhesions, previous surgery or uterine leiomyoma. Foley catheter should be placed just beyond the internal os of the cervix. If the catheter is placed within the cervical canal, it can be easily dislodged. Inadequate seal of the balloon with the internal os will result in leakage of the contrast through the cervical canal, generating inadequate intrauterine pressure to push the contrast out of the bilateral fallopian tubes. This results in false positive result of fallopian tube blockage 9.
- 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.
Common but self-limiting
- abdominal cramping
- per vaginal spotting
- venous intravasation
Rare but serious
- pelvic infection
- contrast reaction
Conditions which may be detected with HSG include:
- uterine congenital anomalies
- submucosal uterine fibroids
- uterine malignancy
- intrauterine adhesions
- uterine (endometrial) polyps
- obliteration of fallopian tubes : 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 2
- tubal polyps 6
- tubal malignancy
- salpingitis isthmica nodosa (SIN) 4
- tubal spasm 6: can be physiological
- 1. Simpson WL, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radiographics. 26 (2): 419-31. doi:10.1148/rg.262055109 - Pubmed citation
- 2. Chalazonitis A, Tzovara I, Laspas F et-al. Hysterosalpingography: technique and applications. Curr Probl Diagn Radiol. 38 (5): 199-205. doi:10.1067/j.cpradiol.2008.02.003 - Pubmed citation
- 3.Tur-kaspa I, Seidman DS, Soriano D et-al. Hysterosalpingography with a balloon catheter versus a metal cannula: a prospective, randomized, blinded comparative study. Hum. Reprod. 1998;13 (1): 75-7. doi:10.1093/humrep/13.1.75 - Pubmed citation
- 4. Creasy JL, Clark RL, Cuttino JT et-al. Salpingitis isthmica nodosa: radiologic and clinical correlates. Radiology. 1985;154 (3): 597-600. Radiology (abstract) - Pubmed citation
- 5. Renbaum L, Ufberg D, Sammel M et-al. Reliability of clinicians versus radiologists for detecting abnormalities on hysterosalpingogram films. Fertil. Steril. 2002;78 (3): 614-8. Fertil. Steril. (link) - Pubmed citation
- 6. Simpson WL, Beitia LG, Mester J. Hysterosalpingography: a reemerging study. Radiographics. 26 (2): 419-31. doi:10.1148/rg.262055109 - Pubmed citation
- 7. Ubeda B, Paraira M, Alert E et-al. Hysterosalpingography: spectrum of normal variants and nonpathologic findings. AJR Am J Roentgenol. 2001;177 (1): 131-5. AJR Am J Roentgenol (full text) - Pubmed citation
- 8. Johnson NP, Hadden WE, Chamley LW. Fertility enhancement by hysterosalpingography with oil-soluble contrast media: reality not myth. AJR Am J Roentgenol. 2005;185 (6): 1654. doi:10.2214/AJR.05.51581 - Pubmed citation
- 9. Zailan A, Karunakaran T, Abu Bakar M, Mian V. The Malaysian Genus Calophyllum (Calophyllaceae): A Review on Its Phytochemistry and Pharmacological Activities. Natural Product Research. 2021;36(17):4569-79. doi:10.1080/14786419.2021.1982936 - Pubmed