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Metrosalpingography (hysterosalpingography)
Last reviewed: 23.04.2024
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To study the uterine cavity and fallopian tubes use a special technique - metrosalpingography. Metrosalpingography (hysterosalpingography) is an X-ray performed after filling the uterine cavity and tubes with a contrast medium through the cervical canal. This study is safe and painless, but it must be performed in aseptic conditions, so as not to infect the infection into the abdominal cavity.
[Methodology and types
On the metrosalpingogram the shadow of the uterine cavity has the appearance of a triangle with slightly concave sides. From the proximal angles of the triangle, narrow shadows of the fallopian tubes begin. The beginning of each tube is indicated by circular constriction, then the tube lumen is conically widened - this is its interstitial part. Then follows a straight or slightly meandering isthmic part with a size of 0.5-1.0 mm. Without sharp boundaries, it passes into the ampullar part, which has the largest diameter at the outer end, facing downwards. If the pipes are passable, then the contrast medium fills them all over, and then in the form of separate clusters is found in the abdominal cavity.
A unique analogue of X-ray metrosalpingography is the radionuclide study of the uterine cavity and tubes - radionuclide metrosleepingography. 1 ml of RFP is injected into the uterine cavity. The cervix is placed on the cervix and the patient is left in the position on the back for 30 minutes. Then a scintigram is produced, on which the image of the uterine cavity and the tubes is obtained. Normally, the drug is distributed in them evenly and within 2 hours completely passes into the abdominal cavity. However, the radionuclide study serves not so much to study the organ morphology as to evaluate its function - the patency of the tubes.
On radiographs you can get an image of the vascular system of the uterus and other pelvic organs. To this end, various methods for X-ray contrasting of the arteries and veins of the uterus and pelvic region, as well as studies of lymphatic vessels and pelvic nodes have been developed. These techniques are used mainly in the diagnosis of malignant tumors of the uterus and appendages.
The image of the internal sexual organs of a woman can be obtained with the help of different ray methods. The main significance among them was acquired by ultrasound scanning (sonography). It has no contraindications and can be produced in all phases of the menstrual cycle and in any period of pregnancy. Especially valuable is the combination of transvaginal and abdominal sonography.
Ultrasound examines the image of the uterus and appendages, assess their position, shape and size. Special preparation for sonography is not required. It is recommended in the morning before the study to drink 2-3 glasses of water and delay urination. A filled bladder provides a better visualization of the internal genitalia. The ultrasonic transducer is moved in two directions: longitudinal and transverse, obtaining respectively longitudinal and transverse sonograms.
On the sonograms of a small pelvis of a healthy woman, a uterus with appendages, a vagina, a bladder, a rectum appear. The vagina forms a tubular structure in the form of a dense echogenic band. The cervix lies on the median line, and its body is usually slightly deflected to the right or to the left. The contours of the uterus are even, its walls give a uniform image. The overwhelming majority of the examinees can distinguish the uterine cavity. The endometrium causes a thin echogenic band in the early proliferative phase, but thickens to 0.4-0.7 cm by the end of the secretory phase.
After determining the position and shape of the uterus, calculate its length, as well as anteroposterior and transverse dimensions. The length of the body of the uterus is the distance between the inner throat of the cervix and the bottom; in women of reproductive age, it is 6-8 cm. Anteroposterior and transverse dimensions are the distances between the two most distant points on the anterior and posterior surfaces of the uterus and between the most distant points on the lateral surfaces. These dimensions range from 3.5 to 4.5 and 4.5 to 6.5 cm, respectively. In women giving birth, the size of the uterus is greater than that of nulliparous women. In menopause, they decrease.
Pipes and a wide uterine ligament on sonograms are not visible, and the ovaries look like oval or rounded formations, located near the uterus. Their magnitude varies considerably. In each ovary it is possible to distinguish between the capsule, the cortex and the medulla. It is generally accepted that normal ovaries do not exceed 0.5 times the size of the uterus. During the menstrual cycle, a progressive increase in one of the ovaries is noted in connection with the formation of a follicle in it - a hypoechoic formation with a thin wall. Its diameter daily increases by 0.2-0.4 cm, reaching immediately before ovulation 2.5-3 cm.
Thus, sonography, as well as radioimmunoassay determination of the concentration of lutropin in the blood of a woman, allows you to accurately determine the time of ovulation and formation of the yellow body. These opportunities are used in gynecology to establish the functional usefulness of the menstrual cycle.
On ordinary radiographs, the uterus and appendages do not give an image. They can only see a contraceptive device inserted into the uterine cavity, since most such devices are made from radiopaque materials. Another thing is computer or magnetic resonance tomograms. The bottom, the body and cervix of the uterus, the vagina, the bladder and ureters, the rectum, fatty tissue and pelvic muscles, and the pelvic bones consistently appear on different "slices". The ovaries are not always distinguishable, since they are difficult to differentiate with the contents of the intestinal loops filled.
Complications of metrosalpingography
If the correct procedure is followed, this procedure is not accompanied by side effects. If there is a violation of the procedure, complications may occur: exacerbation of the infection, bleeding, perforation of the uterine wall, the transition of contrast material from the uterine cavity to the venous or lymphatic vessels.