Hysterosalpingography (HSG)

radiographic examination of the uterine cavity and fallopian tubes with injection of contrast medium under fluoroscopic control. The oily contrast media Lipiodol and later Lipiodol Ultra Fluid were used for many years, but have been largely replaced by water soluble contrast media which are generally considered more safe. HSG is best performed at the end of the first week after the menstrual period. The isthmus is most easily distended at this time, and early pregnancy is avoided. The bladder should be empty. Several techniques and instruments exist, including insertion cannulae (e.g. Leech Wilkinson cannula, Green Armytage cannula), suction cannulae (e.g. Malmstrom Westermann vacuum uterine cannula), and balloon catheters (e.g. Foley catheter, Sholkoff catheter). Catheter HSG is generally less traumatic and painful for the patient, and makes it also easier to rotate the patient after insertion of the instrument. The balloon of the catheter is usually inflated in the uterine cavity and pulled downward to the internal os to prevent leakage of the contrast medium (Fig.1). Demonstration of the cervical canal is achieved by injection of contrast medium during extraction of the catheter after deflation of the balloon. Nonfilling of a fallopian tube due to cornual spasm may be alleviated by intravenous injection of 1 mg glucagon.

HJS

Fig.1

Hysterosalpingography (HSG), Fig.1