The categorization of opaque pathologies outside of contrast media in hysterosalpingography which facilitate interpretation: A pictorial review

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This pictorial review categorizes opaque pathologies detected outside contrast areas in hysterosalpingography into pelvic tissue-related abnormalities and foreign bodies to facilitate accurate image interpretation.

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This pictorial review analyzes rare opaque pathologies visible on hysterosalpingography that fall outside the contrast-filled uterine cavity and fallopian tubes. The authors categorize these findings into gynecologic anomalies, such as calcified fibromas and ovarian tumors including dermoid cysts, and non-gynecologic issues like pelvic bone lesions or retained surgical foreign bodies. The study emphasizes the importance of recognizing these incidental radiographic signs to avoid diagnostic confusion, noting that conditions like endometriosis may present as soft tissue masses or calcifications requiring further imaging for confirmation. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Hysterosalpingography (HSG) is a practical and reliable imaging method to evaluate the cervical canal, uterine isthmus, uterine cavity, and fallopian tubes. Using HSG, opaque pathologies outside of contrast media can be detected as well as pathologies of uterus and fallopian tubes. We aim to present and categorize some uncommon and interesting abnormal findings that are located outside of the contrast areas in HSG. This is a pictorial review that depicts various types of HSG images that include opaque pathologies outside of the contrast areas. Images have been extracted from valuable archives collected over 50 yr by professor Shahrzad. A plain pelvic film contains soft tissues of the pelvis, bony structures, artifacts, or foreign bodies. Categorization might easily help the radiologist to interpret the HSG cliché. Opaque pathologies outside of contrast area in HSG can be categorized into 2 groups: "Pelvic Tissue Related" and "Foreign Bodies". Pelvic tissue abnormalities might have a gynecologic or non-gynecologic source. Foreign bodies can be located in the pelvis or outside of the body. HSG is a reliable and inexpensive procedure. Familiarity with the pathologies of pelvic tissues and the accurate interpretation of HSG images are important.
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Section

Firoozeh Ahmadi, Fattaneh Pahlavan, and Fereshteh Hosseini: participated in study design and data collection. Fattaneh Pahlavan and Fereshteh Hosseini wrote the manuscript. Firoozeh Ahmadi supervised the writing of manuscript. Fereshteh Hosseini collected and embedded images in the manuscript. All authors read and approved the final manuscript and take responsibility for the integrity of the data.

Coi Statement

The authors declare that there is no conflict of interest.

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europepmc
last seen: 2026-10-11T09:27:45.537177+00:00
pubmed
last seen: 2026-10-08T21:44:23.379930+00:00
unpaywall
last seen: 2026-05-21T05:10:58.409756+00:00
License: CC-BY-NC-4.0