Ultrasound Exam Ordering Guide

• Hysterosonogram
• HyCoSy
• Fluoroscopic HSG

For most evaluations of the uterus and adnexa, it is usually most appropriate to order US Complete pelvic anatomy, female, transabdominal and endovaginal imaging.

• Order US Hysterosonogram IMG2875 if you are specifically interested in characterizing endometrial abnormalities (e.g., polyp, submucosal fibroid). Additional details below.
• Order US Hysterosonogram with CONTRAST ENHANCED IMG6311, also known as Hysterosalpingo Contrast Sonography (HyCoSy), to evaluate the endometrium as well as the fallopian tubes.
• A fluoroscopic HSG (FL Hysterosalpingogram (aka HSG)) IMG166 can be ordered to evaluate for uterine cavity and fallopian tube abnormalities. If fluoroscopic HSG is unavailable, US Hysterosonogram with CONTRAST ENHANCED (HyCoSy) IMG6311 can be performed as an alternative. Both FL Hysterosalpingogram and HyCoSy can evaluate tubal patency (“tube check”). Additional information below.

US Hysterosonogram (US HSG) - IMG2875 

This exam has two parts: a pelvic US followed by transvaginal US with distension of the uterine cavity (aka saline-infused sonohysterogram). A catheter is inserted through the cervical os to the uterine cavity, and the uterine cavity is distended with sterile saline. Distention of the uterine cavity allows better assessment of the endometrium and potential abnormalities such as polyps or submucosal fibroids. A common indication for this test is abnormal uterine bleeding.

• Contraindications: Active pelvic infection or untreated sexually transmitted infection, possible pregnancy
• Timing: 7-11 days after the beginning of a menstrual period

Patients may be referred to the UCSF web page “Preparing for an US Hysterosalpingogram (HSG) Exam” for additional information.

More information is available at: https://www.radiologyinfo.org/en/info/hysterosono

Fluoroscopic Hysterosonogram (FL HSG) - IMG166

Fluoroscopic HSG is an examination of the uterus and fallopian tubes using a special form of x-ray called fluoroscopy and iodinated contrast material. The main purpose of the exam is to evaluate the shape or inner cavity of the uterus and for tubal obstruction and/or hydrosalpinx. A catheter is inserted into the uterine cavity (see US HSG above) and contrast is injected into the uterine cavity and fallopian tubes.

• Contraindications: Pregnancy or possible pregnancy, active pelvic infection or untreated sexually transmitted infection, allergy or allergic-like reaction to iodinated contrast
• Timing: 7-10 days after the beginning of a menstrual period

Patients may be referred to the UCSF web page “Preparing for a Fluoroscopic Hysterosalpingogram (HSG) Exam” for additional information.

US Hysterosonogram (US HSG) with CONTRAST ENHANCED aka Hysterosalpingo-Contrast Sonography (HyCoSy) - IMG6311

In recent years, ultrasound with an intra-cavitary ultrasound contrast agent has been added as an alternative to fluoroscopic HSG. Hysterosalpingo-Contrast Sonography (HyCoSy) involves instilling ultrasound contrast through a transcervical catheter to assess the uterine cavity for filling defects and for tubal patency. Like US hysterosonogram and fluoroscopic HSG, the exam is minimally invasive with rare complications. Advantages include the lack of ionizing radiation and more comprehensive evaluation with ultrasound evaluation of the uterus, endometrial cavity, ovaries, fallopian tubes, and pelvis in one setting.

HyCoSy PPT info sheet 1.14.20 UCSF Medical Center.pdf

• Contraindications: Pregnancy or possible pregnancy, active pelvic infection or untreated sexually transmitted infection, allergy or allergic-like reaction to the microbubble contrast agent Lumason© or Polyethyl glycol (PEG)
• Timing: 7-11 days after the beginning of a menstrual period

Patients may be referred to the UCSF web page “Preparing for a Hysterosalpingo-Contrast Sonography (HyCoSy) Exam” for additional information.