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