Appearance of Uterine Scar Due to Previous Cesarean Section on Hysterosalpingography: Various Shapes, Locations and Sizes

Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes that is used predominantly in the assessment of infertility and evaluation of abnormalities of the uterus and fallopian tubes. Some of the abnormalities that can be detected by HSG include congenital anomalies, polyps, leiomyomas, synechiae and adenomyosis. HSG is also used to evaluate any scarring on the uterus and fallopian tubes.

Cesarean section is the most commonly performed surgical procedure involving the uterus in fertile women. Cesarean section involves an incision made in the lower uterine segment or isthmus. Various changes in the site of the cesarean incision may be seen due to wall weakness and fibrosis. The scar may have various shapes; unilateral or bilateral, single or multiple, wedge-shaped or linear. Awareness of the appearance and locations of uterine defects due to previous cesarean section is necessary in order to differentiate them from normal variations and other pathologies mimicking it.

In this study, we demonstrate the appearance of anatomic defects of the uterine cavity on HSG after cesarian section. We define different shapes such as thin linear defect, focal saccular outpouching, unilateral or bilateral diverticula (dog-ear like) and fistula and different locations such as the uterine body, lower uterine segment, uterine isthmus and the upper endocervical canal.