E1908. Hysterosalpingography: A Relevant Artform Not Yet Down the Tubes!
  1. Shruthi Suresh; Geisinger
  2. Beatriz Olivera; Geisinger
  3. Jeffrey Ortiz; Geisinger
  4. Charles Brown; Geisinger
With the advent of MRI and the increasing involvement of gynecology in performing basic diagnostic imaging, many younger radiologists may find themselves unfamiliar with performing and interpreting hysterosalpingograms (HSGs).The purpose of this educational exhibit is to review the purpose, technique and interpretation of HSGs.

Educational Goals / Teaching Points
We first review normal anatomy, which is paramount to the understanding of this modality and demonstrate examples of pathology including Mullerian duct anomalies, the appearance of common abnormalities like polyps, fibroids, scar tissue and more specific infertility related pathology such as salpingitis isthmica nodosa and hydrosalpinx. We additionally demonstrate corresponding imaging correlates on ultrasound and pelvic MRI to help consolidate understanding of the aforementioned pathology. We also discuss the use of this modality in confirming success of tubal ligation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Identify the location of the Infundibulum, ampulla, isthmus and normal uterine contour on an HSG. Understand the preparation and technique required to perform an HSG. Understand the indications and contraindications of an HSG. Understand the imaging appearance of Mullerian duct abnormalities on HSG. Know what abnormalities to look for on the filling, filled and spillage stages of an HSG. Know how to differentiate air bubbles from real endometrial defects. Understand what common pathology like polyps, fibroids and adenomyosis looks like on HSG. Know what hydrosalpinx looks like on HSG. Know the normal and abnormal imaging for post tubal ligation imaging and the imaging appearance of micro-inserts.

HSG remains a cost-effective and useful modality to diagnose important uterine pathology that may be missed on other modalities. Given the more recent trend shift toward relying on pelvic MRI and gynecologists performing their own diagnostic imaging, it is important for radiologists in training to gain a deeper understanding of the advantages and shortcomings of this modality.