THE SIGNIFICANCE OF ENDOMETRIAL FILLING DEFECTS DETECTED ON ROUTINE TRANSVAGINAL SONOGRAPHY

The objective of this study was to compare endometrial filling defects detected on transvaginal sonography performed without distending medi a with findings on hysterosalpingography. Forty-three infertile patien ts were studied in the follicular phrase. Of these, 17 patients had en dometrial contour abnormalities detected on vaginal sonogram and 26 pa tients had no filling defects on ultrasonography. Ultrasonography of t he endometrium and hysterosalpingography were performed on all patient s as part of a routine workup for infertility. Patients with contour a bnormalities detected on either hysterosalpingography or transvaginal ultrasonography underwent hysteroscopy. When a contour abnormality was detected on vaginal sonogram, hysterosalpingography confirmed a defec t in 94% of the cases and hysteroscopy in 100% of the cases. Seven of 26 subjects (27%) with normal vaginal ultrasonograms had abnormal hyst erosalpingograms; however, only two patients with a normal sonogram ha d abnormal hysteroscopic findings. Filling defects seen on hysterosalp ingography that were not detected on sonography include synechiae, and cornual polyps. This study indicates that vaginal ultrasonography is an accurate tool in the identification of submucous fibroids and polyp s. If the examination is performed in the follicular phase, use of dis tending medium is not necessary to detect major abnormalities of the e ndometrium. Synechiae are not, however, visible without distention of the endometrial cavity.