The significance of endometrial filling defects detected on routine transvaginal sonography

The objective of this study was to compare endometrial filling defects detected on transvaginal sonography performed without distending media with findings on hysterosalpingography. Forty-three infertile patients were studied in the follicular phrase. Of these, 17 patients had endometrial contour abnormalities detected on vaginal sonogram and 26 patients had no filling defects on ultrasonography. Ultrasonography of the endometrium and hysterosalpingography were performed on all patients as part of a routine workup for infertility. Patients with contour abnormalities detected on either hysterosalpingography or transvaginal ultrasonography underwent hysteroscopy. When a contour abnormality was detected on vaginal sonogram, hysterosalpingography confirmed a defect in 94% of the cases and hysteroscopy in 100% of the cases. Seven of 26 subjects (27%) with normal vaginal ultrasonograms had abnormal hysterosalpingograms; however, only two patients with a normal sonogram had abnormal hysteroscopic findings. Filling defects seen on hysterosalpingography that were not detected on sonography include synechiae, and cornual polyps. This study indicates that vaginal ultrasonography is an accurate tool in the identification of submucous fibroids and polyps. If the examination is performed in the follicular phase, use of distending medium is not necessary to detect major abnormalities of the endometrium. Synechiae are not, however, visible without distention of the endometrial cavity.