Asherman syndrome

  Asherman syndrome, also known as uterine synechiae, is a condition characterised by the formation of intrauterine adhesions, which are usually sequela from injury to the endometrium, and is often associated with infertility. Epidemiology There is a tendency for the condition to develop soon after pregnancy (usually within four months 9). The incidence is thought to be increasing probably as a result of increased use of intrauterine interventions. Clinical presentation Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain 1. Pathology Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring 1. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. genital tuberculosis). The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue. Radiographic features Hysterosalpingogram Intrauterine adhesions are typically seen on HSG as multiple irregular linear filling defects (may give a lacunar pattern), with the inability to appropriately distend the endometrial cavity 2. In severe cases, there can even be complete non-filling of the uterine cavity.