Week 10 - Hysterosalpingography
HSG usually performed ___ - ___ days after onset of menstration
7 - 10
Uterine cavity is outlined, demonstrating it's shape & contour which can aide in the detection of...
Any uterine pathologic process
Why are hysterosalpingograms done? For which clinical indications
Assessment of female infertility - diagnose functional or structural defects ex. blockage of uterine tubes - therapeutic (injection of contrast may dilate or straighten a tube) - Verification of tubal ligation
Endometrial polyp
Benign growths that acts as a foreign body and interfere with implantation of the embryo. In an HSG - filling defect seen in cavity
How is an HSG done? Contrast is injected through the ________
Cervix
Intrauterine adhesions
Filling direct seen in uterine cavity due to scar tissue. Caused by intrauterine surgery or infection, treated surgically
What is required for patient preparation of HSG?
Fully explain the procedure and possible complications INFORMED CONSENT
What is the Trendelenburg position? Why is it used during HSG?
Head down, feet up Why? so contrast fills uterus and goes out fallopian tube
HSG can be done for assessment of female infertility and/or ...
Intrauterine Pathological Process (Symptoms - abnormal uterine bleeding, pelvic pain, pelvic fullness) (Can also demonstrate lesions)
HSG can also diagnose ...
Pelvic masses Fistulas Habitual spontaneous abortions Congenital defects
What scout is taken before HSG?
Pelvis
Contrast continues to fill the uterine cavity allowing for the patency of the uterine tubes to be demonstrated as contrast spills into which cavity?
Peritoneal cavity
Contraindications for HSG
Pregnancy Active pelvic inflammatory disease Active uterine bleeding
What must always be checked before HSG?
Pregnancy status
What is a hysterosalpingogram? (HSG)
Radiographic demonstration of the female reproductive tract with a contrast agent - Uterus (uterine cavity) - Uterine (fallopian) tubes & their potency (degree of openness)
What is the lithotomy position?
Supine with the knees and hips flexed and thighs spread open
Double uterus
Uterus is completely divided into two (uterus didelphys). It is possible to have two cervices as well
Contrast media for HSG?
Water soluble iodinated contrast (cramping is felt when contrast is going in)
Most common pathological infection for HSG
female infertility
Correct full spelling of HSG
hysterosalpingogram..
Device might be needed to aid the insertion and fixation of the cannula or catheter during the HSG
tenaculm forceps
Why must bladder be emptied before exam?
to prevent displacement of uterus and tubes
Instrument that may be used to dilate the opening of the cervix for catheter placement during the HSG
uterine sound
What is used to dilate/open the cervix
uterine sound
The contrast medium preferred by most radiologist for HSG
water soluble iodinated contrast
Female Reproductive System Anatomy
**Notice how ovary and uterine tubes are not connected, which is why contrast spills into peritoneal cavity
Evaluation Criteria
- Centered pelvic ring - Visualization of cannula or balloon within cervix - Opacified uterine cavity and uterine tubes centered - Contrast seen w/in peritoneum and uterine tubes patent - Density and contrast adequate to demonstrate anatomy/contrast
Why is a water soluble iodinated contrast used in an HSG?
- Easily absorbed by patient - Does not leave residue within the reproductive tract - Provides adequate visualization - Causes pain, may last for hours after exam
Patient preparation for HSG
- Empty bladder immediately before exam to prevent displacement of uterus and tubes - Physicians may perform manual pelvic exam (rare) - Scout x-ray of pelvis