Pnm-1: Applications of Hysterosonography for The Detection of Intracavitary Uterine Abnormalities

Hysterosonography (SHG) is a new noninvasive technique that involves the slow infusion of sterile saline solution into the uterus during ultrasound imaging. Expansion of endometrial cavity by SHG allows optimal visualization and plays an important role in the evaluation of abnormalities related to the uterus. The most common indications for hysterosonography are: abnormal uterine bleeding both pre and post-menopausal,investigation on of infertility and recurrent miscarriage, endometrial assessment for patients on tamoxifen therapy, congenital uterine malformation, abnormal hysterosalpingogram, indirect assessment of tubal patency, retained foreign body such as IUD, post-abortal placental remnants, endometrial synechia, polyp, fibroids, endometrial neoplasia or hyperplasia. SHG is a relatively easy technique. The entire procedure usually takes about 5-10 minutes. In this technique after a baseline transvaginal ultrasound the cervix is exposed with a sterile speculum and gently cleaned with Betadin, balloon-tipped silicone urine fully catheter is advanced through the cervical canal and into the lower uterine segment. After distention of the balloon the speculum then is exchanged for an endovaginal ultrasound probe. This is followed by the instillation of 5-20 cc sterile saline through the catheter under direct ultrasound guidance until an adequate distention of the uterine cavity was obtained. The entire endometrial cavity to the cervical canal was investigated .Uterine abnormalities that can be detected at SHG include congenital anomalies and acquired endometrial anomalies which includes polyps, leiomyomas, hyperplasia and synechiae. SHG has known as a first line investigation modality in diagnosis of uterine abnormalities. According the literature hysterosonography offers adequate visualization and characterization of intrauterine lesions with high sensitivity (90-100%) and specificity (40-98%) compared to diagnostic hysteroscopy. SHG as a reliable, simple, feasible, time efficient, cost-effective and non-invasive method is currently regarded as the preoperative diagnostic procedure and can reduce indications for diagnostic hysteroscopy.