Hysterosonogram

1. Hysterosonogram By: Whitney Pearson

2. Basic Definitions • Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus). • Tubal ligation- Fallopian tubes are surgically cut or blocked off to prevent pregnancy

3. Hysterosonogram • A baseline transvaginal ultrasound is first performed to view the endometrium, including its thickness and any ovarian abnormality. • The doctor then inserts a speculum into the vagina. A small catheter is then inserted and placed directly behind the cervix. The sonographer then inserts the transvaginal probe into the vagina. The doctor will infuse a sterile saline solution into the vagina. The ultrasound will show the saline in the vagina making any abnormalities in the endometrium easy to detect. • It is a valuable technique for evaluating unexplained vaginal bleeding that may be the result of uterine abnormalities such as: polyps, fibroids, scarring, masses or congenital defects.

4. Hysterosonogram set up

5. Case study

6. Patient history • 34 year old female • Gravida 2, Para 0, Abora 2 • Symptoms- heavy, irregular bleeding • Patient is scheduled for an ablation and possible tubal ligation • A ultrasound guided Hysterosonogram is first needed to be done before the ablation

7. Baseline ultrasound images Saggital view of the uterus Transverse view of the uterus

8. Due to this transverse image of the uterus, the sonographer and radiologist had a suspicion that the patient may have a Bicornuate uterus. This image shows that there may be 2 possible funduses.

9. A transvaginal ultrasound was performed 2 endometrium are also seen Uterus 1 Uterus 2 2 distinct fundus are seen in these transverse images.

10. A 3-D image of the uterus is then rendered to demonstrate the Bicornuate uterus

11. 2 fundus are confirmed. The sonographer then needs to see if the patient has 1 or 2 cervix. 1 Cervix • This images shows only one cervix.

12. Bicornuate- Unicalus uterus • 2 uterus’s are shown • The radiologist describes this as a Bicornuate-Unicalus uterus. • Bicornuate means 2 uterus • Unicalus means 1 cervix

13. Clip stores demonstrating the fluid being infused into the uterus Catheter

14. Fluid flushed into the right uterus

15. Fluid is flushed into the left uterus, a polyp is seen in the fundus

16. Complete transverse sweep from fundus to cervix

17. A polyp is seen in the left endometrium Right Left

18. Blood flow is seen within the polyp

19. Final Diagnosis • Bicornuate- Unicalus uterus with a polyp in the left endometrium. • The polyp will be removed from the left Uterus. • A Bicornuate- Unicalus uterus does not need any additional surgery. Both Uterus’s will stay in place.