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 distinct fundus are seen in these transverse images.
2 endometrium are also seen
Uterus Uterus 2

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.
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.