Hystersalpingography Notes
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HYSTEROSALPINGOGRAPHY The radiographic examination of the uterine cavity & the fallopian tubes following the injection of radiopaque contrast material. HYSTEROSALPINGOGRAPHY Anatomic Considerations Vagina ¾Extends from vulva (external genitalia) to the uterus ¾Made up of three layers Outer - muscular Middle - erectile tissue Inner - mucous membrane which is continuous with lining of uterus HYSTEROSALPINGOGRAPHY Anatomic Considerations Uterus ¾Located partly in the vagina & partly above ¾Two main parts Body - upper dome-shaped portion called the fundus Cervix • opening into the vagina is called the external os • opening into the uterine cavity (body) is called the internal os HYSTEROSALPINGOGRAPHY Anatomic Considerations Fallopian Tubes ¾Extend laterally from superior angle of uterus bilaterally ¾About 4 inches long ¾Consists of three parts Isthmus - inner, constricted portion attached to uterus Ampulla - outer, dilated portion that curves over ovaries Infundibulum • opens into abdominal cavity • surrounded by fimbriae • attached to ovaries by fimbria ovarica HYSTEROSALPINGOGRAPHY Anatomic Considerations Ovaries Ampulla Isthmus ¾Oval-shaped ¾Located on each side of the uterus Infundibulum ¾Contains graafian Isthmus follicles which Vagina contain the ova Fundus Fallopian Tube Fimbriae Uterus Cervix Ovary HYSTEROSALPINGOGRAPHY Indications & Contraindications Indications - Diagnostic ¾ Abnormal uterine bleeding ¾ Patency of fallopian tubes ¾ Congenital uterine anomalies ¾ Habitual abortion ¾ Amenorrhea ¾ Preop evaluation for localization ¾ Post-op evaluation ¾ Locate ectopic or lost contraceptive devices ¾ Dysmenorrhea Indications - Diagnostic ¾ Pelvic masses ¾ Fistulae ¾ Cervical stenosis ¾ Malignancy ¾ Endometrial polyps ¾ Leiomyoma Indications - Therapeutic ¾ Restore patency of fallopian tubes ¾ Stretch tubal adhesions ¾ Straighten kinks ¾ Dilate tubes HYSTEROSALPINGOGRAPHY Indications & Contraindications Contraindications ¾Acute or sub-acute pelvic inflammation ¾Vaginal or cervical infection with purulent discharge ¾Active uterine bleeding ¾Pregnancy is generally considered an absolute contraindication, except in special cases ¾Not advised during the immediate pre- or postmenstrual phase HYSTEROSALPINGOGRAPHY Contrast Media The ideal contrast medium ¾Rapid absorption & excretion rates ¾Sufficient radiographic density ¾Adequate viscosity ¾Does not cause general or local reaction ¾Ability to delineate anatomic structures HYSTEROSALPINGOGRAPHY Contrast Media Oily medium ¾ Viscosity - high ¾ Radiopacity - very good ¾ Absorption rate - very slow, may take months ¾ Toxicity - not observed unless decomposed oil is used ¾ Allergic reactions - not observed ¾ Peritoneal reactions - only with large volumes, none with small ¾ Pain - none with small volumes under low pressure ¾ Dangers - Intravasation, pulmonary embolism Water-soluble medium ¾ Viscosity - lowmoderate ¾ Radiopacity - moderate ¾ Absorption rate prompt (20-60 min.) ¾ Toxicity - rare ¾ Allergic reactions occasional ¾ Peritoneal reactions mostly transient ¾ Pain - nearly always ¾ Dangers - none HYSTEROSALPINGOGRAPHY Contrast Media Negative contrast agents (carbon dioxide) may be used after the positive agent in some conditions (about 100 ml) Dose ¾About 4 ml. to fill uterine cavity ¾An additional 4 ml. to examine the fallopian tubes ¾More may be required for some disease conditions HYSTEROSALPINGOGRAPHY The Procedure Patient preparation ¾Should be performed between the 5th & 12th days of the menstrual cycle ¾Empty bladder, irrigate vagina, & cleanse the perineal region ¾Generally, no pre-meds required ¾History ¾Lithotomy position with slight Trendelenburg HYSTEROSALPINGOGRAPHY The Procedure Procedure ¾Cervix is exposed with a bivalved speculum ¾Specialized cannula is introduced into the cervical os ¾Fractional injections of contrast under fluoro HYSTEROSALPINGOGRAPHY The Procedure - Filming AP CR HYSTEROSALPINGOGRAPHY The Procedure - Filming Optional ¾RAO or LAO ¾Rt.. or Lt.. Lateral ¾PA If oily media is used, patient must return for 24 hour film(s)
