E2580. Beyond Tubal Occlusion: A Pictorial Review of Common and Uncommon Pathologies on Hysterosalpingogram with MRI Correlation
  1. Debra Whorms; Hospital of the University of Pennsylvania
  2. Matthew Morgan; Hospital of the University of Pennsylvania
Hysterosalpingography (HSG), one of the oldest imaging techniques used to evaluate the female reproductive tract, remains one of the first-line imaging studies in the work up of infertility. While the primary goal is to evaluate tubal patency, there is a wide range of common and uncommon pathologies that can be identified on HSG and can be contributing factors to infertility. Knowledge of these pathologies and awareness of the appearance on HSG allow radiologists to provide a more accurate interpretation and better guide further patient evaluation and management.

Educational Goals / Teaching Points
By the end of this review, the participant should be able to Identify normal anatomy of the female reproductive tract on HSG, identify normal variable appearance of the uterus and congenital anomalies on HSG, predict common and uncommon causes of contour and cavitary abnormalities, based on HSG appearance, and correlate abnormalities on HSG with findings on magnetic resonance imaging (MRI) and vice versa.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
There is a wide range of structural pathology implicated in fertility, several of which are detectable by HSG. However, while the sensitivity and accuracy of HSG are reported greater than 90% in identifying tubal occlusion, there is high variability in detection of other abnormalities, with overall detection rate as low as 21% in one study. Here we will review pathologies beyond tubal occlusion that are important to identify on HSG, with direct correlation with the appearance on cross-sectional imaging, particularly MRI. Abnormalities on HSG will be characterized as congenital anomalies, contour abnormalities, cavitary abnormalities, and tube/peri-tubal disease. We will cover common and uncommon causes of different types of HSG abnormalities including leiomyomas, adenomyosis, endometrial polyps, synechiae, post-surgical/iatrogenic appearances such as myomectomy, and adhesive extrauterine disease. We will also review the normal variable appearances and common mimics to pathology on HSG.

Knowledge of normal appearance, variants and the wide range of pathology encountered on HSG, can improve utility of hysterosalpingography in work-up of infertility, beyond tubal occlusion. By providing correlation with cross-sectional imaging/MRI, we aim to expand diagnostic framework of radiologist and improve accuracy of detection and interpretation of commonly encountered pathologies on HSG.