Asherman syndrome (intrauterine adhesions) can result from curettage or genital tuberculosis. Which HSG finding is MOST specific for Asherman syndrome?
- A Bilateral cornual block
- B Beaded appearance of the fallopian tubes
- C Irregular filling defects or a 'lacy' pattern within the uterine cavity, with or without partial or complete cavity obliteration ✓
- D Funnel-shaped proximal tube obstruction
Correct answer: C. Irregular filling defects or a 'lacy' pattern within the uterine cavity, with or without partial or complete cavity obliteration
Explanation
Asherman syndrome on HSG shows irregular filling defects, a 'lacy' or 'moth-eaten' pattern, or frank partial/complete uterine cavity obliteration due to fibrous adhesions. The filling defects are caused by synechia bands preventing contrast from filling the entire cavity. Bilateral cornual block and beaded tubes are features of genital TB; TB can also cause Asherman-like changes but the most specific HSG sign of adhesions is the filling defect pattern. Hysteroscopy is the gold standard for diagnosis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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