Sonohysterography to Evaluate Uterine Defects on Hysterosalpingography and Its Correlation with Hysteroscopy

Sonohysterography (SHG) may replace hysteroscopy as the standard method to evaluate intrauterine filling defects noted on hysterosalpingography (HSG). Twenty-six patients with evidence of intrauterine filling defects on HSG underwent SHG in the office with transvaginal ultrasonography before diagnostic or operative hysteroscopy. Polyps were identified in 11 women by SHG and were confirmed by hysteroscopy and histology. Adhesions seen on SHG in four women were also confirmed by hysteroscopy. Thus SHG not only correctly identified myomas in all six patients, but helped determine which ones could be resected by hysteroscopy and which might benefit from preoperative gonadotropin-releasing hormone analog treatment. Five patients with intrauterine filling defects on HSG were subsequently shown to have normal endometrial cavities at SHG and hysteroscopy. We believe SHG is a useful technique for evaluating patients with abnormal HSGs, reducing the requirement for more expensive and invasive diagnostic hysteroscopy. In addition, it provides more thorough assessment before operative hysteroscopy.