What are some abnormalities seen on a hysterosalpingogram?
Previous episodes of pelvic inflammatory disease (PID) or endometriosis can cause damage to the muscle of the fallopian tubes, the “myosalpinx,” and result in tubal dilation known as hydrosalpinx. Such patients may have infertility or recurrent ectopic pregnancies in the abnormal tubes.
Salpingitis isthmica nodosa is another important cause of tubal infertility; it is seen in ≈25% of women with a previous history of PID. Outpouchings of contrast material are seen in the isthmic segments of the fallopian tubes on HSG. These outpouchings cause tubal dysmotility, leading to infertility or ectopic pregnancies.
Uterine abnormalities account for ≈10% of cases of infertility and early trimester pregnancy losses. Congenital anomalies may occur in the uterus but are usually associated with premature labor rather than miscarriages. Uterine leiomyomas are a common benign tumor in women but rarely cause infertility; they may be seen as filling defects in the endometrial cavity. Adenomyosis is a condition that occurs in women in their late 30s and early 40s and is associated with painful menstruation, pelvic pain, and infertility. MRI is the optimal method to evaluate for adenomyosis, but HSG may show outpouchings of contrast material from the endometrial cavity that suggest the diagnosis of adenomyosis.
Asherman’s syndrome is a triad consisting of a history of D&C after a miscarriage or full-term pregnancy, followed by amenorrhea or scanty menstrual periods, and infertility. On HSG, the uterine cavity is irregular and small due to the presence of intrauterine synechiae.
