IS Case 571: Synechiae of the uterus

Katherine Kaproth-Joslin, MD

Imaging Sciences URMC


Imaging Sciences URMC 2010
Publication Date: 2011-11-17

History

Patient is a 38-year-old female with history of proximal tubal occlusion bilateral and synechiae repaired three years ago, pregnancy a year later, and now with infertility again.

Findings

Hysterosalpingogram showed multiple tubular/linear filling defects within the uterine cavity, consistent with synechiae. There was filling of the fallopian tubes bilaterally, with free spillage of contrast into the peritoneum on both sides.

Diagnosis

Synechiae of the uterus

Discussion

Synechiae, also known as intrauterine adhesions, can result from pregnancy, dilatation and curettage, surgery, and/or infection [1]. They appear as irregular linear filling defects with hysterosalpingography. The endometrial cavity can appear distorted and may not expand as expected with injection of contrast material. When infertility is secondary to uterine adhesions this causes a condition known as Asherman syndrome [1]. To make the diagnosis of Asherman syndrome, the adhesions must be differentiated from normal uterine folds, which can be seen when the uterine cavity is not fully distended [1]. Ultrasound can also be utilized for the evaluation of intrauterine adhesions, appearing as echogenic bands which transverse the endometrial cavity.

References

  1. Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 2009 Sep-Oct;29(5):1353-70. PMID: 19755600

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