Women's imaging is a relatively new subspecialty of diagnostic radiology that encompasses diagnostic tests, and some interventional procedures, that apply to women and fetuses. Texas Radiology Associates has several board certified radiologists with additional specialized training in breast radiology, fetal ultrasonography, and diagnostic evaluation of the female reproductive organs. Breast biopsies, diagnosis of complex anomalies of the uterus, ovarian masses, fallopian tube abnormalities, and prenatal diagnosis are just a few of the areas of interest. Some specific conditions and procedures are listed below; for more information, click on the topic you would like to explore. We would be happy to discuss any of the topics or procedures with you by telephone or email.
Abnormal Uterine Bleeding
Abnormal uterine bleeding can occur before or after menopause, during pregnancy, or due to cervical cancer. Please see the appropriate section below.
Benign Breast Diseases
There are several benign (noncancerous) diseases of the breast. One of the most common is fibrocystic change. Fibrocystic change causes both fibrosis (thickening of the tissue) and cysts (bags of fluid) in the breast. Fibrocystic change can cause lumps and ridges in the breast and can make the breast tissue look very dense on mammograms, thus making detection of cancers more difficult. Ultrasound is very helpful in conjunction with mammography in looking for cysts. Fibrocystic change is a common cause of breast pain and tenderness, especially in the premenstrual phase of a woman’s cycle.
There are other benign processes in the breasts that are usually easily characterized by the mammogram and/or ultrasound. However, there are areas of overlap between some benign diseases and some types of cancers. These cases will require a biopsy to determine the cause of an abnormality.
Breast Biopsy
Breast biopsies may be recommended because a lump is felt in the breast or an abnormality is seen on a mammogram or breast ultrasound. An abnormality can be directly removed during surgery, or a needle can be placed in the lump and a few cells withdrawn (fine needle aspiration). In the past, all breast biopsies were performed as surgeries. This method is still available. In addition, breast abnormalities can now be biopsied by the stereotactic method. This enables a radiologist to directly visualize the area of concern and place a needle in the breast so that small samples of tissue can be obtained. The advantages of the stereotactic biopsy include no need for general anesthesia, a smaller scar, less tissue is removed therefore there is no defect in the shape of the breast, and less recovery time. The stereotactic method is very accurate in obtaining a diagnosis.
For abnormalities that can be seen with ultrasound, an ultrasound-guided needle biopsy is available. The advantages to this method are the same as the stereotactic needle biopsy mentioned above.
Breast Cancer
One in nine women will be diagnosed with breast cancer during their lifetime. The primary goal is early detection, as the cure rate is much higher with smaller cancers. Yearly screening mammography plays a primary role in early breast cancer detection. Mammography can detect tumors that are too small to be felt, as well as calcifications and areas of tissue distortion, all of which can be signs of cancer. However, mammography can't find all the cancers. Up to 10% of cancers will not be apparent on mammograms and these cancers must be found by a good breast physical examination. A woman should perform self-breast examination once a month (near the same time each month), as well as obtain a yearly breast exam by her physician.
Breast Implants
Breast implants can impair detection of breast cancer because they are dense on mammograms and obscure some of the normal breast tissue. This requires special mammographic pictures in which the implants are pushed out of the way, but even with the special views, some normal breast tissue is obscured by the implants.
In addition, implants can rupture. There are two types of implant ruptures. Intracapsular ruptures are contained within a fibrous shell that the body forms around an implant, while extracapsular ruptures break outside the fibrous shell. Mammography is not ideal for detecting implant ruptures. Often ultrasound and especially Magnetic Resonance Imaging (MRI) are required for the diagnosis. MRI with a special breast imaging coil is probably the best way to evaluate suspected implant rupture.
Cervical Carcinoma
Cervical carcinoma is another cause of bleeding, and can occur in premenopausal or post menopausal women. Cervical carcinoma is usually detected early with routine pap smears or colposcopy. Imaging does not play a significant role in the diagnosis of cervical cancer, but MRI is helpful in some cases for staging the cancer.
Ectopic Pregnancy
Ectopic pregnancy, often referred to as a tubal pregnancy, is a serious and sometimes life threatening condition. Normally, an egg is fertilized and travels to the uterus to implant. If something interrupts this process, a fertilized egg can implant in the fallopian tube. This can not only cause pain, but the ectopic pregnancy can rupture and cause hemorrhage. The diagnosis requires a combination of findings on ultrasound and clinical tests.
Endometriosis
Endometriosis is a condition in which the lining of the uterus, the endometrium, grows outside of the uterus. Endometriosis can grow on the ovaries, on the bowel, on the peritoneum (the lining of the body cavity) and can even go as far away as the chest. Endometriosis can cause mass-like areas of growth called endometriomas.
The diagnosis is made by a combination of clinical evaluation and imaging. Endometriomas can be found on ultrasound, but MRI is particularly valuable in the evaluation of endometriomas and endometrial implants.
Treatment of endometriosis may involve drugs, surgery, or a combination of the two.
Fetal Ultrasound (See image)
Ultrasound is an invaluable tool in the detection of abnormalities of the fetus as well as abnormal fetal growth. It is a readily available test, for which the expectant mother lies comfortably on a table while a trained sonographer images the fetus by gliding a probe over the surface of the woman’s abdomen. There is no special preparation necessary for a fetal ultrasound examination, and it can be performed at any time during gestation.
Your doctor may order an ultrasound to determine the fetal age and establish your due date when the last menstrual period is unknown. In fact, first trimester (less than or equal to 12 weeks) ultrasound is extremely accurate in dating the pregnancy, within 5 days. Dating in the second and third trimesters is less accurate due to variability of fetal growth.
Another common reason for early ultrasound is vaginal bleeding or spotting. Ultrasound is then used to evaluate the location of the fetus, and rule out an ectopic pregnancy. If the fetus is normally positioned in the uterus, specific criteria are used to determine if it is growing normally. In many cases, the fetal structures are measured and then correlated with blood tests specific to pregnancy.
Later in pregnancy, a full anatomic survey may be ordered to look for fetal anomalies. Abnormalities of the fetus can be difficult to see, but prenatal ultrasound can detect problems with the heart, brain, kidneys, and other structures. In addition, there are some signs that could indicate a chromosomal abnormality in the fetus and therefore make amniocentesis (testing of the fluid surrounding the fetus) an important option. The significance of some abnormal findings may not be established without follow-up studies performed later in pregnancy or associated clinical tests. And it is important to keep in mind that fetal ultrasound is not perfect--subtle abnormalities may be overlooked and others are beyond the scope of ultrasound. In addition, a normal fetal ultrasound tells nothing about the potential intelligence of your unborn child.
Ultrasound is used to monitor complicated pregnancies (such as twins, for example) in assessing fetal growth. MRI can be used to further evaluate fetal abnormalities that cannot be adequately assessed on ultrasound. This usually requires that the mother be given a sedative so that the fetus won't move. Motion severely impairs MRI images.
Fibroids/Uterine Leiomyomata
Uterine fibroids, also called uterine leiomyomata, are a common cause of pelvic pain and other symptoms, including abnormally heavy bleeding during menstrual periods or bleeding between periods. These benign tumors of smooth muscle grow on the uterus, and can become very large. This can result in compression of surrounding structures, which may cause pain, constipation, urinary frequency, and other symptoms. Ultrasound is the preferred method of initial evaluation for uterine fibroids. However, it can miss fibroids that are less than 2cm in size. MRI of the pelvis provides the most accurate depiction of size, number, and location of the fibroids, and is commonly ordered as a preoperative study prior to any kind of fibroid treatment.
Fibroids that are causing intractable pain or bleeding can be managed in several ways. The fibroids can be individually removed in a procedure called a myomectomy. This is particularly useful when a woman wants to maintain fertility, and can be done through an abdominal incision or laparoscopically. Fibroids can often be treated by cutting off their blood supply in a procedure called uterine artery embolization. This is discussed in greater detail in the interventional radiology section.
Simple Or Hemorrhagic Ovarian Cysts
Cysts due to normal ovulation can cause pain. Often these ovulatory cysts can bleed, or they can rupture and cause pain. These are best evaluated initially with ultrasound, which includes endovaginal ultrasound. With endovaginal ultrasound, a probe is inserted into the vagina in order to get a closer look at the uterus and ovaries. If there is a cyst on the ovary and the woman is still menstruating, often all that is required is a repeat ultrasound following the next menstrual period (in 6 weeks) to be sure the cyst resolves.
Hysterosalpingography (“HSG”)
A hysterosalpingogram (HSG) is of most value in the evaluation of patency and morphology of the fallopian tubes, although it also helps in the evaluation of the uterine cavity and cervical canal. It provides a good initial screen in the evaluation of uterine anomalies or uterine masses, which may be the cause of failure to become pregnant and recurrent fetal loss.
The test is readily available as an outpatient procedure and is performed between day 1 and day 10 of the menstrual cycle (with day 1 being the first day of the menstruation). This is to avoid performing the study in the presence of an intrauterine pregnancy. If there is any question of the possibility of a pregnancy, a pregnancy test may be performed before the procedure. And, as well, an HSG is not performed in a woman who is actively bleeding to avoid flushing blood clots out of the fallopian tubes and into the peritoneal cavity. Some physicians prescribe a short course of antibiotics, as there is a small risk of pelvic infection, particularly in the setting of fallopian tube dilation from previous infection.
The procedure takes 15-30 minutes and is performed with the patient lying on a fluoroscopy table. A speculum is used to visualize the cervix and the cervix is cleansed with a sterile soap. A thin, soft catheter is placed into the cervix and a small balloon at the tip of the catheter is inflated to hold it in place. Most patients do not experience any discomfort, some report slight cramping. Clear liquid contrast material (“x-ray dye”) is instilled into the uterine cavity and x-ray images are taken. Depending on the findings, other tests may be needed.
Infertility
There are many causes of infertility, many of which can be diagnosed with radiologic tests, and others, which can only be diagnosed by clinical means. The following is a discussion of many of the radiologic tests that are commonly ordered as part of an infertility workup.
Magnetic Resonance Imaging
MRI is often employed when a congenital abnormality of the uterus is suspected. Congenital anomalies, also called Mullerian duct anomalies, result from nondevelopment or varying degrees of nonfusion of the Mullerian ducts (precursors of the uterus and fallopian tubes found in a female fetus). These anomalies occur in 1-15% of women. Hysterosalpinography and ultrasonography often suggest that an anomaly is present but are often inconclusive. And, before the advent of MRI, precise diagnosis was made only by surgery. MRI has proven to be an accurate and noninvasive method of diagnosing malformations of the uterus and associated complications. This is particularly important in cases where surgical repair is contemplated.
This is an axial image through the female pelvis revealing a heart shaped uterine cavity (arrow), representing a form of a Mullerian (See image) duct anomaly called an arcuate uterus.
MRI also provides the most accurate description of the precise size, location and number of uterine fibroids in women who undergo myomectomy or uterine artery embolization. MRI can accurately diagnose a condition called adenomyosis, a cause of infertility, pain, and abnormal uterine bleeding. Before the advent of MR,I this diagnosis could only be made at surgery, since it is not possible to differentiate adenomyosis from leiomyomas (fibroids) either clinically or by ultrasound. In fact, the accuracy of MRI in distinguishing adenomyosis from fibroids has been reported to be as high as 90%---an important distinction, as the treatment options are quite different for each.
This is a sagittal image (See image) through the pelvis showing multiple masses in the uterine wall (seen as black round structures; arrows) consistent with uterine fibroids. MRI provides the most accurate description of the size, number and location of fibroids.
MRI is a readily available, safe and relatively fast test that involves no ionizing radiation. The patient lies on her back in a long cylinder-shaped machine with a flat square-shaped device, similar to a heating pad, on her pelvis. Music is played during the exam and the patient can communicate with the technologist via a speaker into the room. Occasionally patients may experience claustrophobia, in which case sedation can be given.
Mammography
A mammogram is an x-ray specially designed for the breast. A standard mammogram includes two separate views of each breast, one from top to bottom (cranio-caudal) and one from side to side (medio-lateral oblique). The breast must be compressed in order to spread the tissue evenly so abnormalities can be seen.
There are 2 basic types of mammograms, “screening” and “diagnostic”. A screening mammogram is done to screen for breast cancer in women who do not have symptoms or other problems relating to the breasts, and includes the standard 4 x-rays of the breasts. A diagnostic mammogram is done to evaluate a specific problem, such as nipple discharge or a breast mass.
A radiologist does not have to be present when a screening mammogram is performed. Screening mammograms are usually interpreted after the patient has left the facility. Screening mammography is performed in order to detect early breast cancers that are not big enough to feel. It is currently recommended that a woman obtain a yearly screening mammogram beginning at age 40. No longer is a "baseline" mammogram at age 35 recommended. However, any woman with increased risk of breast cancer (those with a first degree relative [mother, sister or daughter] diagnosed with breast cancer before menopause) should have a baseline mammogram at an age 10 years less than the age of her relative at the time of the relative's diagnosis.
A radiologist is present during a diagnostic mammogram to ensure that all the pictures necessary to evaluate an area of concern are performed. ANY WOMAN WITH A PROBLEM RELATED TO THE BREAST SHOULD HAVE A DIAGNOSIC EVALUATION REGARDLESS OF HER AGE. There are many situations in which a diagnostic mammogram may be indicated.
Mammograms and diagnostic evaluations can also be performed on men who have enlarged breast tissue or breast lumps.
Membranes
The membranes which surround the fetus, the amnion and the chorion, should remain intact until near the time of delivery. Ultrasound can evaluate the amount of fluid around the baby in the event of premature rupture of the membranes, which causes fluid to leak out. In addition, uncommonly, the membranes can break and entrap the fetus, called amniotic band syndrome, which can result in severe fetal deformities or even death. Ultrasound will usually detect these amniotic bands and therefore make management decisions easier.
Nipple discharge
Most nipple discharge is benign. The types of discharge that are related to benign causes are white, creamy, milky discharge or a light-green colored discharge. The latter can be associated with fibrocystic disease. Yellow and clear discharge is also usually benign but can rarely be associated with cancer.
Bloody, black, and sometimes clear or yellow nipple discharge is more concerning. Discharge is particularly worrisome when it is spontaneous (does not require mechanical expression), recurring, and on one side from a single duct. Even so, most bloody nipple discharge is the result of a benign lesion called an intraductal papilloma. The evaluation of nipple discharge includes mammograms, possibly ultrasound, and sometimes a study called a galactogram or ductogram. This is a test where x-ray dye or contrast is injected into the breast ducts to see if there is a mass within the ducts.
Obstetrics
Ovarian Torsion
Torsion of the ovary is a very serious condition. Torsion occurs when the ovary twists on the axis of its suspending ligaments and blood supply. This can cut off the blood supply to the ovary and cause extreme pelvic pain. Normal ovaries usually do not twist. Torsion is often seen when there is a large cyst or mass in the ovary.
Ultrasound is the test to assess for torsion. With ultrasound, a radiologist can see the ovary to assess for the presence of a mass and with Doppler, can determine if there is blood flow in the ovary. Rarely, the ovary can twist and cause pain but the blood supply will be maintained. This can be more difficult to evaluate.
Ovarian Tumors
All ovarian masses are best evaluated initially with ultrasound, which includes endovaginal ultrasound. With endovaginal ultrasound, a probe is inserted into the vagina in order to get a closer look at the uterus and ovaries. Ultrasound is usually definitive in the evaluation of ovarian masses, and is often the determining factor in deciding whether to wait and reevaluate at a later time or surgically remove the mass. Ovarian masses that on ultrasound do not demonstrate classic features of a specific entity occasionally require an MRI. By manipulating the technical aspects of MRI, the radiologist can determine what kind of tissue (blood, fluid, fat, etc.) is in the mass and therefore make the diagnosis more accurate.
There are many tumors that can grow from the ovaries, cancerous and noncancerous. Ovarian tumors are often difficult to detect because many do not cause pain until they become very large. Once ovarian tumors become large, they can compress adjacent structures or they can cause the ovary to twist which then cuts off its blood supply resulting in pain (see ovarian torsion). Most ovarian tumors are discovered because they cause pain or are detected on a routine gynecological examination.
A common benign (noncancerous) tumor of the ovary is the ovarian dermoid or teratoma. This is a mass that arises from rests of cells in the ovary that maintain the potential to create any kind of human tissue. These tumors often contain odd tissues such as hair, teeth, and fat. Rarely these tumors can have cancerous potential but are more often a concern because of the predisposition for torsion or pain.
Another benign tumor is the cystadenoma. These are more likely to occur in older women, but can occur at any age. If not treated, they can reach very large sizes. They can be very difficult to distinguish from the malignant cystadenocarcinoma, which can look similar.
There are more rare tumors of the ovary that are less likely to cause pain and are often referred to as the solid tumors. These are most often benign but can be malignant as well. Some of these tumors can secrete hormones that can result in symptoms such as facial hair, weight gain, etc. These same symptoms can be seen in polycystic ovarian disease or Stein-Levinthal syndrome, which can also be detected with ultrasound.
Pelvic inclusion cysts (PICs) can mimic ovarian tumors. These occur in women who have had surgery and continue to ovulate. The adhesions and scar tissue that form after surgery can entrap an ovary. The ovary continues to ovulate and secrete fluid, causing large cysts or collections of fluid to form around the ovary. Diagnosis of PICs requires experience with this entity. The diagnosis can be made with ultrasound and MRI in the appropriate clinical setting. The treatment requires drainage and ovarian suppression instead of surgery.
Ovarian Tumors (cancers and noncancers)/pelvic inclusion cysts
There are many tumors that can grow from the ovaries. These can be cancerous and noncancerous. Ovarian tumors are difficult to detect because many do not cause any symptoms until they become very large. Once ovarian tumors become large, they can compress structures or they can cause the ovary to twist, which then cuts off its blood supply resulting in pain (see ovarian torsion). Most ovarian tumors are discovered because they cause pain or are detected on a routine gynecological examination. See "OvarianTumors" for more detailed information.
Pelvic Inflammatory Disease
Pelvic infections can cause pain. The pain associated with pelvic infection is usually acute in nature and associated with fever. The diagnosis of pelvic infection is usually clinically based; however, ultrasound can be very helpful in evaluating the complications of pelvic infection. An entity referred to as a tubo-ovarian abscess can sometimes result from infection. This is an abscess that forms when an infection extends from the uterine cervix to the uterus and from there involves the fallopian tubes and ovaries. A related problem is a hydrosalpinx, where the fallopian tube becomes dilated and filled with fluid or pus. Ultrasonography is integral in making the diagnosis when the clinical findings are equivocal in the acute phase. Hysterosalpinography can be used after the acute problem resolves, to determine if the fallopian tubes are blocked as a result of infection.
Pelvic Pain
There are many conditions that can cause pelvic pain, including uterine fibroids (leiomyomas), endometriosis, pelvic inflammatory disease, adenomyosis, hemorrhagic ovarian cysts, ovarian tumors (benign or malignant), pelvic inclusion cysts, pelvic congestion syndrome, retained ovarian syndrome, ovarian torsion, and ectopic pregnancy. The most common of these conditions are discussed below.
Pelvic Venous Congestion
Placenta
During the fetal ultrasound examination, the placenta is evaluated for its location and configuration. There are abnormalities of the placenta that can threaten a pregnancy. One is called placenta previa. This occurs when the placenta grows too low in the uterus and actually covers the outlet of the uterus, the cervix. This can cause bleeding and requires a cesarean section at the time of delivery.
The placenta can also grow too deep into the uterus, forming too strong an attachment so that it doesn't separate at birth. Depending on the degree of uterine invasion, the process is called a placenta accreta, placenta increta, or placenta percreta. Placenta percretas can grow all the way through the uterine wall and even invade the bladder. These usually require a hysterectomy as treatment at the end of the pregnancy. Placenta acreta, increta, and percreta usually occur in women who have had cesarean sections in the past and the placenta implants in the area of the cesarean section scar.
There is also a condition in which the placenta can separate from the uterus too early, called placental abruption. This usually causes pain for the mother and results in bleeding between the uterus and the placenta. Abruptions can be small and not adversely affect the pregnancy, or they can be large and immediately threaten the pregnancy.
Placentas can also be insufficient in the delivery of nutrients and oxygen to the fetus, which can impair fetal growth and development. This can happen without any known cause, but can be related to maternal disease such as hypertension or drug use. Ultrasound is integral in monitoring fetal growth and with Doppler, the blood flow to the fetus and the blood flow in the placenta can be evaluated.
MRI can be used to evaluate the placenta as well as the fetus. It is particularly valuable in assessing placenta percreta. Obstetrical MRI requires that the mother be sedated in order to decrease fetal movement, as motion severely degrades the images and therefore compromises diagnosis.
Retained ovarian syndrome
The retained ovarian syndrome occurs in women who have undergone a hysterectomy (removal of the uterus) where the ovaries were left behind. The ovary (ies) can fall into the space that the uterus used to occupy. The ovary then lies at the vaginal cuff (the deep part of the vagina). The ovary can be trapped in scar tissue as the vaginal cuff heals, causing pain. This often includes pain during intercourse. An endovaginal ultrasound can detect an ovary lying at the vaginal cuff.
Simple cysts
Cysts due to normal ovulation can cause pain. Often these ovulatory cysts can bleed, or they can rupture and cause pain. These are best evaluated initially with ultrasound, which includes endovaginal ultrasound. With endovaginal ultrasound, a probe is inserted into the vagina in order to get a closer look at the uterus and ovaries. If there is a cyst on the ovary and the woman is still menstruating, often all that is required is a repeat ultrasound following the next menstrual period (in 6 weeks) to be sure the cyst resolves.
Sonohysterography
Sonohysterography (sono-HSG) was first described in the early 1980's but is not yet in widespread use. It is highly “operator dependent”, which means it requires a certain level of expertise both in performing the test and in interpreting the findings. All of the women’s imaging specialists at Texas Radiology Associates have specialized training and extensive experience in performing this procedure. It involves the use of ultrasound while sterile saline is infused into the uterine cavity with a special catheter. The saline spreads the lining of the uterus out so that abnormal areas can be seen better than on routine ultrasound, where the lining is collapsed. Sonohysterography not only makes the diagnosis of endometrial masses much easier, but also identifies the exact area of the problem, allowing more accurate surgical removal.
In premenopausal women, sono-HSG should be performed at approximately day 6-10 of the menstrual cycle (with the first day of bleeding being day 1) to ensure that the patient is not pregnant. A slight amount of cramping may be experienced, but pain is not common. There is a small risk of infection, particularly in women who have weakened immune systems, in which case antibiotics may be administered.
This is a transvaginal image (See image) of the uterus revealing marked thickening of the lining, also called the endometrium. However, the cause is not evident.
This is an image (See image) of the uterine cavity filled with sterile saline at sonohysterography. It reveals a mass growing inside (arrow), which represents a polyp.
Ultrasound (breast)
Ultrasound is used as an adjunct to mammography and can help determine the cause of an abnormality seen on a mammogram. Ultrasound is also very helpful in assessing a lump in the breast, especially in younger women. A very common breast mass is a simple cyst (bag of fluid), which is easily diagnosed with ultrasound and usually requires no treatment. Ultrasound is not useful as a screening tool for cancer but can be used to help guide biopsies of abnormalities in the breast.
Ultrasound (pelvis)
Ultrasonography is a readily available imaging modality that involves no ionizing radiation. Instead it utilizes sound waves to produce an image of the organ being evaluated. It is highly operator dependent, which means it requires a level of expertise both in performing the test and interpreting the findings and is the cornerstone of pelvic imaging. It provides a detailed evaluation of the uterine body and the lining of the uterus, the endometrium. Potential causes of infertility such as uterine malformations, masses or dilated fallopian tubes can be diagnosed. Congenital uterine anomalies range from lack of development (uterine agenesis) to a completely duplicated uterus (uterus didelphyus). Pelvic ultrasound using transvaginal technique is inadequate for making an accurate description of the abnormality but may be the initial test that suggests an unusual configuration of the uterus.
Almost invariably, ultrasonography is the best way to image the ovaries, as it gives detailed evaluation of ovarian cysts or masses including the internal architecture, which provides information about the character of the mass.
Ultrasound can be performed transabdominally, with the probe on the abdomen, or transvaginally. Transvaginal technique involves insertion of a special ultrasound probe into the vagina. Minimal, if any, discomfort is experienced, similar to a speculum exam at a gynecologic visit. It provides the most accurate description of the uterus and ovaries as it allows the closest proximity to the pelvic organs. The uterus and ovaries can be imaged in any plane and real time evaluation allows accurate diagnoses to be made.
This is an image (See image)of the uterus using transvaginal technique, providing a detailed look at the muscular wall and endometrium.
This image (See image) is an example of first filling the uterine cavity with water and then using transvaginal ultrasound to scan can enhance evaluation of the endometrium. This is called sonohysterography (see discussion under "Abnormal Uterine Bleeding"). Often, abnormalities in the uterine cavity seen on a hysterosalpingogram will be further evaluated with sonohysterography as it provides precise location and definition of endometrial masses, which are potential sources of infertility.
This is an image (See image) of the uterine cavity filled with sterile saline at sonohysterography. It reveals a mass growing inside, which represents a polyp.
Magnification during the examination clearly depicts the stalk (arrow) from which the polyp arises.(See image).
