FINDINGS:
1-Hysterosalpingography may show normal findings, which will show a healthy, normally shaped uterus and unblocked fallopian tubes which permits egress of free inverted comma shaped contrast spillage into the peritoneal cavity bilaterally.
2-Hysterosalpingography findings include intra-uterine filling defects, congenital uterine anomalies (Mullerian anomalies), tubal disease such as proximal, middle or distal tubal occlusion with or without hydrosalpinx, endometriosis, salpingitis isthmica nodosa, T-shaped uterine deformity in females who have been exposed in utero to diethylstilbestrol, vesicovaginal fistula, uterovesical fistula and infantile uterus.
3-Intra-uterine filling defects are commonly caused by intra-uterine adhesions, submucous fibroids, and endometrial polyps.[7] Intra-uterine filling defects due to polyps and submucous fibroids are usually smooth and well-defined whereas intra-uterine filling defects due to adhesion are usually irregular and ragged and may cause reduction in size of uterine cavity depending on the severity of the intra-uterine adhesion. On the other hand, fibroids and endometrial polyps in addition to causing luminal filling defects, will also cause uterine cavity enlargement and sometimes deformities.
4-Tubal blockage are very common hysterosalpingographic findings and are usually due pelvic inflammatory disease.[1,2,3,4,5,6,7] This usually manifest as unilateral or bilateral tubal blockage and with or without hydrosalpinx. There could be contrast intravasation and visualization of uterine and ovarian veins in complete tubal blockage. Often times contrast intravasation occurs in excessive injection pressure. Findings in the tubes also include peri-tubal and peri-fimbral adhesions.
5-Hysterosalpingographic findings is accurately diagnostic in mullerian anomalies of the uterus leading to uterine septum, unicornuate uterus, biocornuate uterus and uterus didelphys.[6,7] These mullerian anomalies are cause by either absence of fusion of the two mullerian systems or partial/incomplete fusion of the mullerian system during embryogenesis.
6-Hysterosalpingography can distinguish septate uterus from bicornuate uterus by measuring the cornual angle which in bicornuate uterus is usually more than 60°.
7-Findings at hysterosalpingography include T-shaped uterus in female patients exposed to diethylstilbestrol in utero, endometriosis interna (adenomyosis) which appears as multiple flask shaped contrast-filling out-pouching, salpingitis isthmica nodosa seen as small blobs or out-pouching of contrast out of the tubal lumen in the isthmus region, presumably representing small diverticula.
8-The etiology of salpingitis isthmic nodosa is not clear there appears to be a relationship to endometrosis.