Hysterosonography

Definition

Hysterosonography, which is also called sonohysterography, is a new noninvasive technique that involves the slow infusion of sterile saline solution into a woman's uterus during ultrasound imaging. Hysterosonography allows the doctor to evaluate abnormal growths inside the uterus; abnormalities of the tissue lining the uterus (the endometrium); or disorders affecting deeper tissue layers. Hysterosonography does not require either radiation or contrast media, or invasive surgical procedures.

Purpose

Hysterosonography is used to evaluate patients in the following groups:

• perior postmenopausal women with unexplained vaginal bleeding
• women whose endometrium appears abnormal during baseline ultrasound imaging
• women with fertility problems. Infertility is sometimes related to polyps, leiomyomas (fibroids), or adhesions inside the uterus. Adhesions are areas of tissue that have grown together to form bands or membranes across the inside of the uterus
• women receiving tamoxifen therapy for breast cancer

Hysterosonography is useful as a screening test to minimize the use of more invasive diagnostic procedures, such as tissue biopsies and dilation and curettage (D&C). Hysterosonography can also be used as a follow-up after uterine surgery to evaluate its success.

Precautions

Hysterosonography is difficult to perform in patients with certain abnormalities:

• Cervical stenosis. Cervical stenosis means that the lower end of the uterus is narrowed or tightened. It complicates the insertion of a tube (catheter).
• Adhesions or large fibroids. These growths sometimes block the flow of saline fluid into the uterus.

Patients with active pelvic inflammatory disease (PID) should not be tested with hysterosonography until the disease is brought under control. Women with chronic PID or heart problems are given antibiotics before the procedure.

Description

A hysterosonography is preceded by a baseline ultrasound examination performed through the vagina. This allows the doctor to detect an unsuspected pregnancy and to assess the thickness and possible abnormalities of the patient's endometrium. The doctor then inserts a catheter into the uterus and injects sterile saline fluid while ultrasound imaging is recorded on film or videotape. The procedure takes about 10 to 15 minutes.

Preparation

Patients do not require special preparation apart from the timing of the procedure. Patients with fertility problems are examined during the first 10 days of the menstrual cycle. Patients who may have polyps are usually examined at a later phase in the cycle. The best time for examining women with fibroids is still under discussion.

Aftercare

Aftercare consists of advising the patient to contact her doctor in case of abnormal bleeding, fever,or abdominal pain. Some spotting or cramping is common, however, and can usually be treated with nonsteroidal anti-inflammatory drugs, such as ibuprofen.

Risks

The chief risks are mild spotting and cramping after the procedure.

Normal results

Normal findings include a symmetrical uterus with a normal endometrium and no visible masses or tumors.

Abnormal results

Abnormal findings include adhesions; polyps; leiomyomas; abnormal thickening of the endometrium; or tissue changes related to tamoxifen (Nolvadex), which is a drug given for breast cancer.

PERIODICALS

Cullinan, Joanne, et al. "Sonohysterography: A Technique for Endometrial Evaluation." RadioGraphics 15 (May 1995): 501-514.

Huntington, Diane K. "Invited Commentary." RadioGraphics 15 (May 1995): 515-516.

Yoder, Isabel C., and Deborah A. Hall. "Hysterosalpingography in the 1990s." American Journal of Roentgenology 157 (Oct. 1991): 675-683.

Rebecca J. Frey

KEY TERMS

Adhesion—An abnormal union or attachment of two areas of tissue.

Contrast medium—A chemical substance used to make an organ or body part opaque on x ray.

Dilation and curettage (D&C)—A surgical procedure in which the patient's cervix is widened (dilated) and the endometrium is scraped with a scoop-shaped knife (curette).

Endometrium—The tissue that lines the uterus.

Fibroid—Another word for leiomyoma.

Leiomyoma—A benign tumor composed of muscle tissue. Leiomyomas in the uterus are sometimes called fibroids.

Pelvic inflammatory disease (PID)—An inflammation of the fallopian tubes, usually caused by bacterial infection.

Polyp—A growth projecting from the lining of the uterus. Polyps can cause fertility problems or abnormal vaginal bleeding.

Saline solution—A solution of sterile water and salt used in a variety of medical procedures. In hysterosonography, saline solution is used to fill the uterus for diagnostic imaging.

Transvaginal ultrasound (US)—The diagnostic imaging procedure that serves as the baseline for a hysterosonographic examination.