Sonohysterogram uterine

Normal test: The dark area within the uterus is the saline filling the uterine cavity. No abnormalities
are seen

Abnormal test. The uterine cavity has an irregular outline consistent with endometrial polyps
(outlined in red and marked by white arrows).

Tubal Patency

Infertility investigations have traditionally included x-ray

hysterosalpingography (HSG) or laparoscopy for the assessment of tubal
patency. Sonohysterography is an alternative technique.

When tubal patency is evaluated, a balloon tipped catheter is required to

appropriately distend the endometrial cavity and to force fluid out of the
fallopian tubes into the cul-de-sac. The infused saline should be shaken in the
syringe - the bubbles that result are easier to see passing through the
fallopian tubes. Color Doppler assessment of the fallopian tubes has also
been used to document tubal patency (Fig. 15). More recently, ultrasound
contrast agents have been employed to assess tubal patency41.

Figure 15.
Doppler illustration
of right fallopian tube
patency. Click for
larger image.

Color

In the presence of bilaterally

occluded fallopian tubes, the
uterine cavity will expand with only
a
limited instillation of
saline
and will not decompress. Patients
will
invariably complain of discomfort from the uterine pressure. The
demonstration of true unilateral occlusion, in contrast to cornual spasm,
cannot be determined during sonohysterography. The rapid egress of fluid
through the fallopian tube with the least resistance can be interpreted as a
unilateral occlusion42.

USG