Tubal imaging is a test used to check the patency of a woman’s fallopian tubes. It is one of the more widely used methods in clinical practice. It is performed by injecting contrast into the uterine cavity and the fallopian tubes through a catheter, and then using an X-ray diagnostic device to perform X-ray fluoroscopy and radiographs.
Overview
A hysterosalpingogram is a method of examining whether the fallopian tubes are patent, the site of obstruction and the morphology of the uterine cavity by injecting contrast into the uterine cavity and fallopian tubes through a catheter and using an X-ray diagnostic device to perform X-ray fluoroscopy and radiographs.
Overview of tubal imaging: It is a test used to check the patency of the fallopian tubes in women. Fallopian tube imaging is one of the more widely used methods in clinical practice.
Tubal angiography: A hysterosalpingogram is a method of examining whether the fallopian tubes are patent, the site of obstruction and the morphology of the uterine cavity by injecting contrast into the uterine cavity and fallopian tubes through a catheter and using an x-ray diagnostic instrument to perform x-ray fluoroscopy and film taking, based on the visualization of contrast in the fallopian tubes and pelvis.
Advantages
It is the most commonly used test to find out whether the fallopian tubes are patent, the degree of patenting and the specific site of blockage, with an accuracy rate of 98% and with certain therapeutic effects. In many ways, it is irreplaceable by ultrasound, CT, MRI, hysteroscopy, laparoscopy, tuboscopy, etc.
Course Hysterosalpingography is a method of injecting a contrast agent into the uterus and fallopian tubes through the internal orifice of the uterus using certain instruments. It is still commonly used in gynecology. In many ways, ultrasound, CT is not a substitute.
Classification of iodinated oil contrast
Commonly used 40% iodized oil (domestic), 30% ethyl iodide oil, etc.
The advantages of oil are: high viscosity, high density, clear image; slow flow, more ample time for film taking; disadvantages: strong irritation, allergic reaction, slow absorption, will remain in the body for up to two years, may stimulate tissue granulomas, aggravate tubal inflammation or cause chronic peritonitis. And it needs to be taken only after 24 hours.
Iodine hydrography
Iodophoresis or iodofol.
The advantages of iodine water imaging are: low osmolarity, low viscosity, high hydrophilicity, diffusion into the secretion of the fallopian tube, high contrast density to show the lumen of the obstruction; fast flow, 15 minutes to complete the film; well tolerated by the human body, low impact on vital weight and heart, liver and kidney function; similar pharmacokinetics in the human body, fast absorption, no obvious binding to serum or plasma proteins, no obvious metabolism, deionization or biotransformation. It does not cross the blood-brain barrier, has no significant toxicity to the central nervous system and does not cause any significant epithelial damage, and is absorbed in 10-30 min after injection and later excreted through the urine by the kidneys.
Indications
1. Infertility It is used to understand the cause of primary or secondary infertility. It can not only understand the presence of congenital malformations or pathological conditions in the uterus and fallopian tubes, but also whether the tubes are patent, so as to find the cause of infertility. In some cases, after hysterosalpingography, it can lead to the patency of the incompetent fallopian tubes and conception.
2. Abnormal uterine bleeding To find the cause of abnormal uterine bleeding, to understand the condition of uterine mucosa and uterine cavity, and to determine whether the abnormal bleeding is due to endometrial polyp or submucosal myoma.
3.Tubal recanalization To recanalize the fallopian tubes after tubal ligation, it is necessary to understand the condition of the uterine tubes to decide whether surgery can be performed.
4.Tumor Observe the effect of uterine fibroids, adnexal tumors and other pelvic organs on the uterine fallopian tubes.
5.Diagnosis of malformation Uterine malformation such as bicornuate uterus, longitudinal uterus, etc.
6.Foreign body diagnosis Metal intrauterine device ectopic.
7.Adhesion diagnosis Uterine adhesions, cervical adhesions, etc.
Contraindications
1.Acute and subacute inflammation of the reproductive tract. Such as vaginal cleanliness II to III degree.
2.Serious systemic diseases, such as heart and lung diseases.
3.Normal delivery, miscarriage, scraping or within 6 weeks after delivery; scraping of endometrium within 4 weeks.
4.Menstrual period, uterine or cervical bleeding.
5.Iodine allergy.
6, fever.
7, Menopause has not yet ruled out pregnancy.
Reason for examination
High-precision tubal angiography (SSG) is to perform selective tubal cannulation angiography under X-ray fluoroscopy, and then select the specific site of tubal patency or obstruction for guidewire separation of adhesions according to the high-precision tubal angiography, using the propulsive and dilatory separation effect of the catheter and cook guidewire and the impact of the contrast agent to unblock the tubes to the umbilical end.
Under direct X-ray vision, the specific site of tubal incompetence or obstruction is accurately targeted for direct separation of adhesions by guidewire, and the catheter is placed directly on the part of tubal adhesions for contrast and release of adhesions, and anti-adhesion medication is injected under pressure at the same time. The chance and degree of restoration of patency are far superior to other methods.
Tissue structure
The wall of the fallopian tube is similar to that of other cavernous organs in that it is composed of a mucosal layer, a muscular layer and a plasma membrane layer from the inside out.
I. Mucosal layer
The mucosal layer includes the epithelium and the underlying fibrous connective tissue layer, which is also called the lamina propria. The mucosal layer has many folds protruding into the lumen along the long axis of the fallopian tube, and each fold has a second or even third level of branching protrusions. Thus, in the transverse section of the fallopian tube, the lumen of the tube is occupied by numerous folds. The thickness of the mucosal layer and the number of folds vary, with the mucosal layer in the abdomen being the thickest and with the most folds, and the lumen in this part is longitudinal and transverse, resembling a labyrinth. The isthmus has fewer folds, and the interstitial part is even shorter and less.
(1) Ciliated cells: ciliated cells are taller and wider, with grayish, reflective cytoplasm and more pronounced perinuclear halo. The cytoplasm contains uniform fine particles.
(2) Secretory cell: also known as non-ciliated cell, the cytoplasm is deeply stained and covered with microscopic granules, and the nucleus is ovoid, deeply stained, with dense nuclear chromosomes. The secretory cells are more obvious at the base of the epithelial folds and between the folds, and their morphology and position of the nucleus vary with the menstrual cycle.
(3) Wedge cells: Wedge cells show a nucleus that is extruded between the cells, with deep and narrow staining, and little or no cytoplasm. There are microvillous protrusions with cytoplasm formation at the top edge under electron microscope. In premenstrual period and menstrual period, wedge cells are more numerous and obvious.
(4) Undifferentiated cells: also called wandering cells. The cells are small and round, located deep in the epithelium and as large as white blood cells. The cytoplasm is few and bright, and the nucleus is centrally located and deeply stained.
II. Intrinsic membrane
The lamina propria under the epithelium is a loose connective tissue composed of fine fibers, containing many stray cells and mast cells. The fallopian tube lacks mucosal muscle layer, so the lamina propria migrates directly to the connective tissue of the muscle membrane. The lamina propria is lined with blood vessels, a network of lymphatic vessels and unmyelinated nerves, and the jugular abdomen is particularly vascular. In tubal pregnancy, the connective tissue within the lamina propria can be transformed into metaplastic cells.
III. Myometrium
The myometrium of the fallopian tube is connected to the myometrium of the uterus, and the longitudinal muscle of the innermost layer of the uterus to the isthmus disappears. Thus, in cross-section, the myometrium is divided into 3 layers, but there is no clear demarcation between the 3 layers. The inner layer is the intrinsic myometrium of the fallopian tube near the mucosal layer, which is the thickest and can be divided into 3 different groups of myofascicles, the inner and outer longitudinal spiral myofascicles in opposite directions and the middle dense spiral circular myofascicle; the middle layer is outside the intrinsic myometrium and consists of a network of myofibrils, which is accompanied by blood vessels, and the myofibrils around such vessels enter the intrinsic myometrium. The outer layer is a longitudinal subplasma muscle layer, which is more obvious above the fallopian tube and gradually disappears downward when connected to the broad ligament.
IV. Blood vessels
The arterial blood of the fallopian tubes comes from the uterine artery (a.uterina) and the ovarian artery (a.ovarica) branches. Generally, the interstitial part and the medial 2/3 of the fallopian tube are supplied by the uterine artery branch, while the other part is supplied by the ovarian artery branch.
The venous flow of the fallopian tube is parallel to the artery of the same name. The inter-arterial capillary network is distributed in the mucosa, muscular layer and plasma layer of the fallopian tube. The intermucosal fold capillary network drains to the vascular plexus between the mucosal and muscular layers, the capillary network between the mucosal and muscular layers drains to the vascular plexus in the muscular layer, and the capillary network in the plasma layer drains to the plasma vascular plexus. All the above three vascular plexuses converge in the subplasma membrane and drain outward along the corresponding veins.
V. Lymph
Lymphatic vessels (vasa lymphatici) are found in the mucosal, muscular and plasma layers of the fallopian tubes, and all three are in communication with each other.
Although the lymphatic systems of the uterus and the fallopian tubes are completely separate, because their lymphatic fluid collects in the subovarian lymphatic plexus and terminates in the para-aortic lymph nodes through a common channel, when the common channel is blocked by infection or tumor, the lesion spreads retrogradely from one organ to the other through the lymphatic vessels.
Sixth, nerves
The fallopian tube is innervated by sympathetic and parasympathetic nerves. Another part of the sympathetic preganglionic fibers emanating from thorax 10 and 11, after synaptic transmission in the abdominal abdominal aorta and renal ganglia, send postganglionic fibers to the ovarian plexus.
The nerve fibers that thus branch out innervate the distal part of the oviductal potbelly and the umbilicus and are adrenergic neurons. In addition, some preganglionic fibers pass through the inferior mesenteric ganglion and inferior ventral plexus and continue anteriorly to the cervical-vaginal plexus, where they then send postganglionic fibers from the peripheral ganglion to innervate the oviduct and proximal part of the jugular abdomen. The postganglionic fibers emanating from the peripheral ganglia are short adrenergic neurons. Thus, the sympathetic nerves of the fallopian tube originate from two parts, i.e., the isthmus is innervated by the inferior ventral plexus and the abdomen of the jugular by the ovarian plexus, with nerves from both long and short adrenergic neurons.
The preganglionic and postganglionic fiber synapses of the parasympathetic nerve (nn. parasympathici) are located near the oviduct, resulting in short postganglionic fibers and long preganglionic fibers, but no ganglia were found in the oviductal muscle wall.
The parasympathetic nerves that innervate the fallopian tubes are: vagal fibers from the ovarian plexus innervate the tubo-potbelly; the pelvic nerve, composed of parasympathetic nerves from sacral 2, 3, and 4, passes to the terminal nerves of the pelvic plexus and sends short postganglionic fibers to innervate the isthmus and interstitium of the fallopian tubes.
Imaging procedure
In the first step, the vagina is dilated and the placental cervix is exposed. The cervix and fornix are disinfected with iodophoresis, the cervical catheter is filled with iodophoresis, the air inside the tube is excluded, the cervical canal is inserted in the direction of the uterine cavity, and the conical rubber tip of the catheter is tightened with the cervical by pulling the cervical clamp to prevent the outflow of the drug.
Step 2: During the tubal imaging, the patient lies supine on the X-ray machine operating platform, routinely disinfects the vulva as well as the vagina, and then spreads a sterile towel before examining the position and size of the uterus.
Step 3: Observe the flow of contrast agent through the uterine cavity under X-ray fluoroscopy.
Step 4: One day later, another picture will be taken in the same area, then observe whether there is free iodine Haiol in the abdominal cavity, if the tubes are not working bilaterally, then there will be no iodine oil in the pelvic cavity, if there is only a small amount of iodine Haiol then long can be considered as the tubes are open but not smooth.
Attention to the selection of imaging time
1. The best time for the procedure is 3-7 days after the patient’s menstruation, and intercourse is prohibited 5 days before the procedure.
2. Atropine 0.5mg can be injected within half an hour before the procedure to reduce tubal spasm.
3.The patient should empty the bladder.
4. Ask if there is any history of iodine allergy. Half an hour before imaging, make iodine allergy test, generally make skin scratch test, apply 2.5% iodine tincture on the flexor surface of forearm, about 2-3cm in diameter, make a scratch on it and observe after 20 minutes for
After 20 minutes, observe whether there is redness and swelling. Conjunctival test or venous test can also be done. Conjunctival test (conjunctival drip method): inject the contrast agent into the conjunctiva of one eye, and after 15 minutes, observe whether the conjunctiva is congested, red and swollen, and compare with the undripped side.
If it appears, it is positive. Intravenous test (intravenous injection method): 30% of the same batch number of contrast agent 1ml intravenous injection, 15 minutes later if no reaction is negative, such as hives, sneezing, chest tightness, metallic taste in the mouth, laryngeal edema, etc., are positive.
5. Those who are constipated can take oral laxative before surgery to keep the uterus in normal position and avoid external pressure artifacts.
Postoperative precautions
1.After the contrast, it is forbidden to take a tub bath and have sex for two weeks, and antibiotics can be given to prevent infection as appropriate.
2.Sometimes tubal spasm causes the illusion of tubal incompetence, repeat if necessary.
3. A small amount of vaginal bleeding within one week after the imaging test is normal if there is no other discomfort.
4. It is best to use contraception for three months after imaging to reduce the possible effects of x-ray exposure. However, clinically it was observed that women who became pregnant in the month after the imaging did not have an increased risk of fetal abnormalities.
5, Chinese herbal medicine regulation, pay more attention to the hygiene situation to avoid inflammatory infections.
Trans-X-ray film reading
Qualified imaging is the first step in diagnosis, while a clear diagnosis is the key to treatment, the same film
Different doctors may come to different conclusions from the same film due to different experience.
1. Normal hysterosalpingogram
2.Interstitial blockage
3.Isthmus blockage
4.Imaging of abdominal blockage
5.Imaging of umbilical blockage
6.Fallopian tube with patency
Side effects
1. Tubal imaging is performed by injecting contrast into the uterus and fallopian tubes and monitoring them under the fluoroscopic view of an X-ray machine. This causes the body to absorb some X-rays. However, the damage caused by transient X-ray exposure is minor and reversible. It is important to pay attention to protection when performing routine X-ray examinations, but there is no need to be afraid.
2, X-ray tubal contrast examination is iodine contrast agent, 40% iodized oil is dense, good contrast effect, but irritation, postoperative abdominal pain, sometimes cause chemical peritonitis, long examination time, slow absorption, easy to cause foreign body reaction, the formation of granuloma, such as a large amount into the vein, there is a risk of oil embolism.
Common problems
Tubal imaging is a method of examining whether the fallopian tubes are open, the site of obstruction and the morphology of the uterine cavity by injecting contrast into the uterine cavity and fallopian tubes through a catheter and using an X-ray diagnostic instrument to perform X-ray fluoroscopy and film taking.
Tubal imaging is a method of examination in which contrast is injected through the cervix to reveal the uterus and the inner lumen of the fallopian tubes. The contrast agent is a 40% iodinated oil or organic iodine preparation. The contrast is injected under fluoroscopy and the film is taken when the uterus and fallopian tubes are adequately visualized and repeated at regular intervals to observe the patency of the tubes.
The time to do the imaging is chosen to be within 3 to 7 days after menstruation. For patients with irregular postmenstrual errors, it can be delayed to 10 days. Patients with special irregularities such as amenorrhea can do it at any time, but the possibility of pregnancy needs to be excluded. In very rare cases, women may have a small amount of vaginal bleeding in the first month after pregnancy, so it is important to exclude pregnancy in women with low menstrual flow and amenorrhea.
How long does it take to get pregnant after contrast?
The time limit for pregnancy after tubal contrast may vary depending on the contrast agent. Some contrast agents may allow pregnancy in alternate months, while others may require three months to six months to conceive.
How soon can you have intercourse after contrast
Intercourse after a tubal imaging is usually only possible after half a month, depending on the patient’s individual situation, and antibiotics should be given to prevent infection.
Tubal imaging is an invasive test, so it is difficult to stimulate, and this stimulation can easily cause vaginal bleeding in women. Vaginal bleeding after the test is normal and usually disappears within 7 days. Under normal circumstances, there is no harm to women. After a tubal angiogram, it is usually necessary to wait for half a month before having intercourse and to use antibiotics to prevent infection.
Avoid bathing and sexual intercourse for two weeks after tubography. Pay attention to vaginal bleeding. A small amount of vaginal bleeding within a week without any other discomfort is normal.
If the bleeding is heavy or exceeds the amount of menstruation and other discomfort, you should contact your doctor promptly. In addition, in order to avoid the harmful effects of X-rays, it is advisable not to rush into pregnancy and it is better to use contraception for three months. However, depending on the tubal contrast agent, the time limit for pregnancy after tubal contrast may vary.
Bleeding after imaging?
Although the damage caused by a tubal imaging test is minimal, it is a foreign stimulus to a woman’s endometrium, which can cause vaginal bleeding. Vaginal bleeding is a normal phenomenon after a tubal screening and usually disappears on its own within 7 days without causing any harm to the woman’s body.
The bleeding after tubal imaging is not an abnormal condition and usually stops automatically in about 3-7 days, so the patient does not need to take any treatment measures or medication to stop the bleeding because it is a normal phenomenon. If more than 7 days have passed, the following conditions may have occurred: infection caused by the imaging, serious endocrine disorders. In this case, it is recommended to go to the hospital for examination in time.
Difference between imaging and lavage
Tubal imaging is a test to check whether the fallopian tubes are open or not. If the fallopian tubes are not open, the sperm cannot unite with the egg and the fluid cannot be discharged, which may lead to a series of tubal problems and eventually lead to tubal infertility.
The difference between tubal imaging and tubal lavage: tubal lavage has a nursery purpose, because the doctor does not know the condition of the tubal lumen before lavage, and does not know whether the patient has tubal distortion, or tubal adhesions or obstruction, so for the majority of infertile women tubal lavage is not effective, and it is only useful for mild adhesions. If the first lavage does not open the tubes, it is useless to perform multiple lavages. Moreover, repeated lavages will destroy the peristaltic ability of the tubes and the wiggling ability of the cilia, and each lavage will increase the chance of infection, especially if the sterilization is not strict.
Tubal imaging can not only visualize whether the fallopian tubes are patent and the site of obstruction, but also observe the size and shape of the uterine cavity, the presence of malformations and the presence of uterine adhesions or occupying lesions. In particular, it is of definite significance in determining the site of tubal obstruction and guiding the choice of treatment plan. In addition, the images are clear and can be preserved permanently, making it easy to compare before and after treatment. The test is safe, does not require anesthesia, is painless, is easily accepted by the patient, and provides a clear basis for the next step in treatment.
When is the best time to have a tubal imaging?
The best time to have a tubal angiogram is on the 3rd-7th day after menstruation because the endometrial environment is most suitable for the test and the test results will be more accurate. If the tubal angiogram is done too early, it can easily cause infection. This is because the woman’s endometrium is invasive and iodinated oil as the contrast agent used in the test can lead to infection. If it is too late and the endometrium is hyperplastic and thickened, then the pressure during the examination may push the thickened endometrium to the entrance of the fallopian tube and cause misdiagnosis of blockage, affecting the effectiveness of the examination and causing bleeding.
Difference between tubal imaging and lumpectomy
Tubal lavage is mainly
It is used to determine the patency of the fallopian tubes according to the resistance of the injection and the reflux of the fluid. The probability of false-positive and false-negative test is too high, which is inaccurate to judge the situation in the body, and also brings great pain to the patient and causes pelvic inflammation and tubal adhesions after the operation, so it is not often used in the clinic anymore.