Sonohysterography: The Next Step in the Evaluation of the Abnormal Endometrium

Abstract

Sonohysterography is a simple ultrasound (US) procedure that may be used to evaluate the endometrium. The technique involves placement of a 5-F catheter into the endometrial canal with subsequent instillation of sterile saline solution under US guidance. Fifty patients successfully underwent sonohysterography because of apparent abnormal endometrial thickening at transvaginal US, a nonspecific finding. Patients tolerated this procedure well, and no complications were encountered. In the 39 patients who proved to have endometrial pathologic conditions, sonohysterography demonstrated focal processes (polyps, carcinoma, hamartoma) in 15, diffuse processes (hyperplasia, secretory endometrium) in 21, and both focal and diffuse pathologic conditions in three. If a focal process can be delineated, a visually directed biopsy may be necessary. However, if the process is diffuse, a blind aspiration biopsy may be performed on an outpatient basis. In the majority of patients, the diffuse or focal nature of the disease could not be predicted on the basis of initial transvaginal US. Because sonohysterography allows distinction between diffuse and focal abnormalities, it provides physicians with a cost-effective way to plan the next step in case management.

Transvaginal Ultrasound scan vs Saline Sonohysterogram in Evaluation of Uterine Intra-cavitary Lesions - Our Experience in India

“…This procedure is indicated for pre-operative evaluation of endometrial cavity to establish the normalcy or to identify the abnormalities, so that it is corrected before the IVF is attempted. Saline sonohysterography is also used when the transvaginal scan is normal but the patient is having symptoms like abnormal uterine bleeding, recurrent abortions or infertility in order to diagnose conditions like uterine anomalies, polyps, submucosal fibroids and uterine adhesions [3], [4], [8][9][10] Procedure Informed consent was obtained from all the patients after explaining the procedure, possible complications like pain, bleeding and infection. [3] Inclusion criteria  Our study included women of age ranging from 20-50 years.…”

“…Cervical os was cannulated using 5 French feeding tube [2], [8], [10] which is attached to a 10ml syringe filled with normal saline. The tube was prefilled with normal saline in order to avoid air bubbles which appear as echogenic foci on ultrasound scan and interfere with accurate interpretation [8], [10] .…”

“…The tube was prefilled with normal saline in order to avoid air bubbles which appear as echogenic foci on ultrasound scan and interfere with accurate interpretation [8], [10] .…”

“…The tube was advanced into the uterine cavity for a reasonable length, for about 5-10 cm [10] . Patient was explained about possible cramping sensation during insertion of the tube.…”

Peri- and Postmenopausal Uterine Bleeding Transvaginal Ultrasound with Hysterosonography and Diagnostic Correlation with Hysteroscopy

“…On histopathologic examination DSJUOG HPE-a typical benign polyp shows fibrotic stroma, irregular endometrial glands and thick-walled blood vessels. 16,17 …”