Presentation
Secondary infertility. Patient has history of three prior dilatation and curettage procedures.
Patient Data
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The uterine cavity is markedly irregular and constricted, compatible with adhesions from prior D&C procedures.
There is also a marked indentation into the uterine cavity at the fundus, which is nonspecific on the hysterosalpingogram, and could represent a large fibroid, an arcuate or septate uterus, or even a bicornuate uterus. A correlative ultrasound (not shown) did not show a large fundal fibroid or a bicornuate configuration, so the indentation is compatible with an arcuate uterus.
There is also non-filling of the right Fallopian tube. The left Fallopian tube fills and spills normally.
Case Discussion
Intrauterine adhesions/synechiae can have a wide variety of appearances, from irregularity of the walls of the endometrium (as in this example) to gross adhesions between the walls, or even elimination of nearly the entire uterine cavity by scar.
One of the possible sequelae of intrauterine adhesions is infertility. It can also result in amenorrhea or chronic pelvic pain.
Adhesions most often occur as a sequelae of instrumentation (as in this case). Pelvic inflammatory disease or intrauterine tuberculosis may also result in adhesions.
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