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1. What is Sonohysterography?

  • Sonohysterography is a type of ultrasound exam.
  • Sterile fluid is put into the uterus through the cervix using a thin plastic catheter or tube.
  • The fluid helps show more detail than when ultrasound is used alone.
  • This test can be done in the clinic.
  • It usually takes less than 20 minutes.

2. For what reasons is a sonohysterography performed?

It can be useful to find the underlying cause of many problems, like infertility and repeated miscarriage. It is able to detect:

  • Abnormal growths inside the uterus, such as fibroids or polyps, and information about their size and depth
  • Scar tissue inside the uterus
  • Abnormal uterine shape
  • Problems with the lining of the uterus
  • Whether the fallopian tubes are open or blocked

3. When to do & When not to do sonohysterography?

  • Sonohysterography is not done if you are or could be pregnant or if you have a pelvic infection.
  • The test usually is scheduled at a time in your menstrual cycle after your period has stopped.
  • If you are bleeding at the time of the test, the results may not be as clear.

4. How to do Sonohysterography ?

  • It is done when bladder is empty.
  • You will be asked to undress from the waist down and lie on an exam table.
  • If we think of any infection, patient may need to take antibiotics to clear up the infection before you have the procedure.

5. What are the main steps of a sonohysterography?
Sonohysterography has three main steps:

  1. performing an initial transvaginal ultrasound exam,
  2. putting fluid inside the uterus, and
  3. repeating an ultrasound exam.

6. How is the fluid put inside the uterus for a sonohysterography?

  • After the first transvaginal ultrasound exam, the transducer is removed.
  • A speculum is placed in the vagina. It holds the vagina open. A swab is passed through the speculum to clean the cervix.
  • Next, a thin tube is inserted into the vagina and placed in the opening of the cervix or inside the uterus. The speculum then is removed.
  • The transducer is placed in the vagina again. A sterile fluid is slowly passed through the tube. Cramping may occur as the fluid goes into the uterus.

7. What happens after the fluid is put inside the uterus for a sonohysterography?

  • When the uterus is filled with fluid, ultrasound images are made of the inside of the uterus and the uterine lining.
  • If the test is being done to assess your fallopian tubes, fluid containing bubbles is placed inside the uterus through the tube.
  • The bubbles make the fluid easier to see. The pathway of the fluid through the fallopian tubes is noted on ultrasound.

8. What can I expect after a sonohysterography?

  • Most women are able to go home right away and are back to their normal activities that day.
  • Some of the following symptoms may occur after the test:
    1. Cramping
    2. Spotting or light bleeding
    3. Watery discharge

9. What are the risks of a sonohysterography?

  • This test is very safe, but there is a rare risk of pelvic infection.

Polyp in endometrium.

  • The typical sonographical appearance of an endometrial polyp is that of a well-circumscribed homogeneous lesion that is isoechoic to the endometrium yet preserves the endometrial-myometrial interface.
  • Endometrial polyps can present in diverse manifestations such as cervical polyps, polyps with feeding vessels, multiple polyps or polyps with cystic change.
  • A less common manifestation is a polyp with a broad base of attachment, a polyp which contains cystic components, or a polyp which contains areas of hypoechogenicity/heterogeneity within the polyp.

Uterine septum

  • A uterine septum is an upside-down, triangular shaped piece of tissue which divides all or part of the uterine cavity in two.
  • The tissue is a left over remnant from normal, embryonic uterine development and is most commonly discovered with an HSG (hysterosalpingogram).
  • The septum may frequently be overseen on routine ultrasound scans, particularly in cases when it is very small/short.
  • The saline appears dark black on the ultrasound.
  • Abnormal growths in the uterine cavity will appear as ovoid, grey to white growths that protrude into the cavity.
  • A cavity that is split will show the black appearing saline separated into two areas ( as seen in the video 2)
  • Normal sonohysterogram.

Normal sonohysterogram, showing a smooth internal lining of the uterus. Black colour denotes the fluid in the cavity.

Irregular uterine cavity

  • The internal lining is irregular. There is posterior homogenous structure which is causing an indentation into the lining suspecting to be a posterior wall fibroid.

Polyp in endometrium.
·  The typical sonographical appearance of an endometrial polyp is that of a well-circumscribed homogeneous lesion that is isoechoic to the endometrium yet preserves the endometrial-myometrial interface.
·  Endometrial polyps can present in diverse manifestations such as cervical polyps, polyps with feeding vessels, multiple polyps or polyps with cystic change.
·  A less common manifestation is a polyp with a broad base of attachment, a polyp which contains cystic components, or a polyp which contains areas of hypoechogenicity/heterogeneity within the polyp.