Fill the cavity slowly, then watch each tube fill and spill freely into the peritoneum; name the site of any block (proximal, distal with hydrosalpinx) and any cavity filling defect or contour abnormality.
Orient first
- Performed in the follicular phase after menstruation stops and before ovulation (cycle day 6–11).
- Proximal block can be spasm; a distal block produces a dilated ampulla (hydrosalpinx) with loculated spill.
- Infection risk: prophylaxis per local protocol; contraindicated in pelvic infection or pregnancy.
Acquire the study
- Pulsed fluoroscopy with collimation; balloon or cannula in the cervix; water-soluble contrast injected slowly; early filling, full filling and post-spill images.
The manoeuvre
- Early filling image: cavity contour and filling defects (polyp, fibroid, synechiae).
- Full cavity: shape — septate, bicornuate, T-shaped, adenomyosis diverticula.
- Each tube: fill along its length and spill; ampullary calibre.
- Delayed image: free spill around bowel loops vs loculated collection (peritubal adhesions).
- Report fluoroscopy time and contrast volume.
What confirms it
- Free intraperitoneal spill from each tube confirms patency of that tube.
What licenses you to exclude it
- Bilateral free spill excludes tubal occlusion; it does not exclude peritubal adhesions or endometriosis.
The classic misread
- Calling cornual spasm a proximal block — repeat after a pause or glucagon/antispasmodic per protocol.
- Calling a venous or lymphatic intravasation spill.