Hysterosalpingography
Encyclopedia
Hysterosalpingography is a radiologic
procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical
canal and usually fluoroscopy
with image intensification. A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material. To demonstrate tubal rupture spillage of the material into the peritoneal cavity
needs to be observed. A synonym to hysterosalpingography is uterosalpingography.
s, Asherman's syndrome
, tubal occlusion and used extensively in the work-up of infertile
women. It has been claimed that pregnancy rates are increased in a cycle when an HSG has been performed. Using catheters, an interventional radiologist can open tubes that are proximally occluded.
The test is usually done with radiographic contrast
medium (dye) injected into the uterine
cavity through the vagina
and cervix
. If the fallopian tube
s are open the contrast medium will fill the tubes and spill out into the abdominal cavity
. It can be determined whether the fallopian tubes are open or blocked and whether the blockage is located at the junction of the tube and the uterus (proximal) or whether it is at the end of the fallopian tube (distal).
The HSG can be painful and it's a good idea to take pain-killers both before and after the procedure to reduce the pain. Many doctors will also prescribe an antibiotic prior to the procedure to reduce the risk of an infection.
An easy way of reducing the pain is to ask the doctor to use a special balloon catheter instead of the standard metal cannula.
of hysterosalpingography in detecting any fallopian tube pathology to be 53% and 87%, respectively, and 46% and 95%, respectively, for any bilateral tubal pathology. The sensitivity was estimated to be 38% in women without risk factors for any tubal pathology, compared with 61% in women with risk factors. For bilateral tubal pathology, these sensitivites were estimated to be 13% without risk factors, versus 47% with risk factors. For bilateral tubal pathology, the sensitivity decreased with age with a factor estimated to be of 0.93 per year.
, allergic
reactions to the materials used, intravasation
of the material, and, if oil-based material is used, embolisation
. Air can also be accidentally instilled in to the uterine cavity by the operator, thus limiting the exam due to iatrogenically induced filling defects. This can be overcome by administering the Tenzer Tilt which will demonstrate movement of the air bubbles to the non-dependant portion of the uterine cavity.
was introduced by Sicard and Forestier in 1924 and remained a popular contrast medium for many decades. Later, water-soluble contrast material was generally preferred as it avoided the possible complication of oil embolism.
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It entails the injection of a radio-opaque material into the cervical
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
canal and usually fluoroscopy
Fluoroscopy
Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
with image intensification. A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material. To demonstrate tubal rupture spillage of the material into the peritoneal cavity
Peritoneal cavity
The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall...
needs to be observed. A synonym to hysterosalpingography is uterosalpingography.
Procedure
The procedure involves ionizating x-rays. It should be done in the follicular phase of the cycle. It is contraindicated in pregnancy. It is useful to diagnose uterine malformationUterine malformation
A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct during embryogenesis...
s, Asherman's syndrome
Asherman's syndrome
Asherman's syndrome , also called "uterine synechiae" or intrauterine adhesions , presents a condition characterized by the presence of adhesions and/or fibrosis within the uterine cavity due to scars...
, tubal occlusion and used extensively in the work-up of infertile
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
women. It has been claimed that pregnancy rates are increased in a cycle when an HSG has been performed. Using catheters, an interventional radiologist can open tubes that are proximally occluded.
The test is usually done with radiographic contrast
Radiocontrast
Radiocontrast agents are a type of medical contrast medium used to improve the visibility of internal bodily structures in an X-ray based imaging techniques such as computed tomography or radiography...
medium (dye) injected into the uterine
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
cavity through the vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
and cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
. If the fallopian tube
Fallopian tube
The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s are open the contrast medium will fill the tubes and spill out into the abdominal cavity
Abdominal cavity
The abdominal cavity is the body cavity of the human body that holds the bulk of the viscera. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the thoracic diaphragm , and its oblique floor is the pelvic inlet...
. It can be determined whether the fallopian tubes are open or blocked and whether the blockage is located at the junction of the tube and the uterus (proximal) or whether it is at the end of the fallopian tube (distal).
The HSG can be painful and it's a good idea to take pain-killers both before and after the procedure to reduce the pain. Many doctors will also prescribe an antibiotic prior to the procedure to reduce the risk of an infection.
An easy way of reducing the pain is to ask the doctor to use a special balloon catheter instead of the standard metal cannula.
Efficacy
A review estimated the sensitivity and specificitySensitivity and specificity
Sensitivity and specificity are statistical measures of the performance of a binary classification test, also known in statistics as classification function. Sensitivity measures the proportion of actual positives which are correctly identified as such Sensitivity and specificity are statistical...
of hysterosalpingography in detecting any fallopian tube pathology to be 53% and 87%, respectively, and 46% and 95%, respectively, for any bilateral tubal pathology. The sensitivity was estimated to be 38% in women without risk factors for any tubal pathology, compared with 61% in women with risk factors. For bilateral tubal pathology, these sensitivites were estimated to be 13% without risk factors, versus 47% with risk factors. For bilateral tubal pathology, the sensitivity decreased with age with a factor estimated to be of 0.93 per year.
Complications
Complications of the procedure include infectionPID
-Medicine:*Prolapsed intervertebral disc, commonly called a "herniated disc"*Primary immune deficiency, disorders in which part of the body's immune system is missing or does not function properly...
, allergic
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
reactions to the materials used, intravasation
Intravasation
As a part of the process of metastasis, intravasation refers to the invasion of a cancer through the basal membrane and into blood vessels.In radiology, intravasation is used to describe penetration of radiographic contrast into the soft tissue lymphatics and veins of a hollow organ as a result of...
of the material, and, if oil-based material is used, embolisation
Embolism
In medicine, an embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body.Embolization is...
. Air can also be accidentally instilled in to the uterine cavity by the operator, thus limiting the exam due to iatrogenically induced filling defects. This can be overcome by administering the Tenzer Tilt which will demonstrate movement of the air bubbles to the non-dependant portion of the uterine cavity.
History
For the first HSG Carey used collergol in 1914. LipiodolLipiodol
Lipiodol also known as ethiodized oil is a poppyseed oil used by injection as a radio-opaque contrast agent that is used to outline structures in radiological investigations. It is used in chemoembolization applications as a contrast agent in follow-up imaging. Lipiodol is also used in...
was introduced by Sicard and Forestier in 1924 and remained a popular contrast medium for many decades. Later, water-soluble contrast material was generally preferred as it avoided the possible complication of oil embolism.
Follow Up
If the HSG indicates further investigations are warranted, a laparoscopy, assisted by hysteroscopy, may be advised to visualise the area in three dimensions, with the potential to resolve minor issues within the same procedure.External links
- Hysterosalpgingography Stepwise procedure and Video: Medchrome
- RadiologyInfo - The radiology information resource for patients: Hysterosalpingography
- http://www.ashermans.org
- http://www.drmalpani.com/hsg.htm