Asherman’s Syndrome On Ultrasound | Scan Clues

Hearing the words “intrauterine adhesions” during a scan can feel unsettling. Asherman’s syndrome describes scar tissue inside the womb that can change periods, cause pain, or make pregnancy harder, and imaging plays a major role in spotting it early.

This guide walks through how ultrasound fits into the workup, what the main scan findings look like, where ultrasound falls short, and how extra imaging steps help your team see the full picture before planning treatment.

What Asherman’s Syndrome Is And How It Forms

Asherman’s syndrome refers to scar tissue bands that form inside the uterine cavity. These scars, called adhesions, stick the front and back walls together or bridge separate areas inside the womb. Many people first hear about the condition while searching for answers about light or absent periods, pelvic pain, or trouble getting pregnant.

Most cases link back to a prior procedure that scraped or suctioned the lining. Dilation and curettage after miscarriage, retained placenta, or heavy bleeding is the classic trigger, especially in a recently pregnant uterus. Other causes include prior surgery to remove fibroids or polyps and rare infections inside the womb.

Scar tissue can range from thin, filmy strands to dense, thick walls that almost close the cavity. That range matters, because mild adhesions may cause little change on imaging, while severe disease can distort the entire cavity and block menstrual flow.

Test Or Procedure	What It Shows	Typical Role In Workup
Transvaginal Ultrasound	Uterine size, shape, basic lining appearance	First look during bleeding problems or infertility
Saline Infusion Sonohysterography	Cavity outline and filling defects from adhesions	Detailed map of scar tissue inside the womb
Three Dimensional Ultrasound	Reconstructed view of the cavity and walls	Helps judge extent and location of adhesions
Hysterosalpingography (HSG)	Dye flow pattern and cavity shape on X ray	Shows blockages and irregular cavity outlines
Standard Pelvic Ultrasound	Broader pelvic view, ovaries, surrounding organs	Checks for other causes of bleeding or pain
Diagnostic Hysteroscopy	Direct camera view inside the womb	Gold standard for diagnosis and treatment planning
MRI Of The Pelvis	Soft tissue detail beyond the cavity	Reserved for complex anatomy or repeat surgery

Asherman’s Syndrome On Ultrasound Findings And Common Clues

Standard transvaginal ultrasound often acts as the first detailed view of the uterus. On this scan, the sonographer places a small probe in the vagina to get close views of the lining and muscle of the womb, while watching changes live on the screen.

When a report hints at asherman’s syndrome on ultrasound, the wording usually describes patterns such as an unusually thin lining, a distorted cavity shape, or bright strands that seem to bridge one wall to the other. None of these signs alone prove the diagnosis, but together they can raise suspicion and prompt more targeted tests.

Endometrial Thickness And Texture

On a normal scan, the uterine lining thickens and thins across the cycle. In someone who has adhesions, that pattern may flatten out. The lining can look thin in large areas, or show patchy segments where some parts respond to hormones while scarred areas stay flat and bright.

Radiology reports may describe an “irregular” or “interrupted” endometrial echo. That language refers to areas where the bright central stripe that usually outlines the cavity looks broken or pulled to one side. In severe cases, parts of the cavity may vanish from view because scar tissue closes off segments.

Bright Bands And Filling Defects

Adhesions often appear as bright, linear echoes inside the cavity. On two dimensional images, they can look like strands or shelves that cross from one wall to another. Scar tissue may also pull the lining into angles, leaving small empty pockets beside the bands.

These findings can overlap with other conditions, such as fibroids that bulge into the cavity or healed infection inside the womb. Because of this, many specialists prefer to confirm any suspicious pattern with a saline infusion scan, where the cavity fills with fluid during ultrasound.

Doppler Blood Flow Patterns

Doppler settings let the operator see blood moving through the uterine lining. In areas with heavy scarring, blood flow can drop. On the screen, this shows up as quiet zones next to normal areas that fill with color. The overall picture helps the team judge how much healthy lining remains for bleeding and potential implantation.

When A Standard Ultrasound May Miss Adhesions

Even a well performed scan can overlook mild intrauterine adhesions. Thin, filmy scars may lie flat along the wall, almost blending into the lining. Adhesions can also hide if the cavity is empty, since the two walls sit together and leave little contrast between tissue layers.

Timing matters too. During the first part of the cycle, the lining stays slim, which makes thin scars hard to tell apart from normal tissue. Scans near the middle or later part of the cycle, when the lining reaches peak thickness, tend to show abnormal areas more clearly.

Because of these limits, practice guidelines on intrauterine adhesions recommend combining ultrasound with other tools such as saline sonohysterography or hysteroscopy when symptoms and history raise concern even if the first scan appears normal.

Saline Infusion Ultrasound For Intrauterine Adhesions

Saline infusion sonohysterography adds a simple step to standard transvaginal ultrasound. A thin catheter passes through the cervix, and sterile saline flows into the womb while the operator watches the screen. The fluid opens the cavity and outlines its inner surface in real time.

In someone with adhesions, fluid may pool on one side of a scar or fail to reach closed segments. The scar bands show up as smooth or ragged lines that interrupt the otherwise dark fluid filled space. Studies report that saline sonography picks up intrauterine adhesions with high sensitivity, sometimes matching or approaching findings seen on hysterosalpingography and other contrast studies.

Patient leaflets from centers such as the Cleveland Clinic Asherman syndrome page describe saline infusion ultrasound as a common step between standard scanning and hysteroscopy during infertility or bleeding workups.

Three Dimensional And Contrast Enhanced Techniques

Some units combine saline infusion with three dimensional reconstruction. The machine collects many two dimensional slices and builds a full model of the cavity. This can reveal the pattern of scars from different angles, which helps surgeons plan where to enter and how far to cut during hysteroscopic removal.

Other centers use gel infusion or contrast agents that show up better on specific ultrasound settings. These methods share the same goal: clearer separation between scar tissue, healthy lining, and the surrounding muscle layer.

Role Of Hysteroscopy Alongside Imaging

Even with careful use of ultrasound, hysteroscopy remains the reference method for diagnosing intrauterine adhesions. During hysteroscopy, a slim camera passes through the cervix, allowing the surgeon to see scars directly and cut them under vision. Practice guidance from groups such as the American College of Obstetricians and Gynecologists, reflected in the ACOG hysteroscopy FAQ, lists hysteroscopy as the preferred tool for both diagnosis and treatment of intrauterine pathology.

Ultrasound still matters during this process. Preoperative scans help rule out large fibroids or congenital uterine shapes that might change the approach. Intraoperative ultrasound can guide the hysteroscopic scissors or energy devices in severe cases, keeping the surgeon within the natural cavity and away from the muscle wall.

Ultrasound Finding	What It May Suggest	Common Next Step
Thin, uniform lining after prior surgery	Global endometrial damage or mild adhesions	Saline sonohysterography to map cavity
Bright bands crossing the cavity	Adhesions bridging opposing walls	Plan for saline scan and hysteroscopy
Irregular cavity margin with small pockets	Mixed scar tissue and healthy lining	Referral to a fertility surgeon
Fluid trapped in one part of the cavity	Blocked outflow due to dense scar	Hysteroscopy to open the segment
Areas with reduced Doppler flow	Poorly vascular lining near scars	Review of treatment options and timing
Normal scan with ongoing symptoms	Possible thin or flat adhesions	Plan saline scan or HSG
Distorted cavity after past infections	Combination of scars and muscle changes	Joint imaging and surgical planning

Asherman’s Syndrome And Fertility Workups

Many people learn about adhesions while seeking answers for trouble conceiving or miscarriage. In this setting, ultrasound does double duty. It screens for common issues such as fibroids or polyps and, at the same time, checks for hints of scar tissue that might interfere with implantation or blood flow to a pregnancy.

Specialists often time saline scans to the part of the cycle when the lining is thinnest but still visible, so that adhesions stand out clearly against the fluid filled cavity. Findings then feed into a shared plan for surgery, medical treatment, and later conception attempts, whether natural or with assisted reproduction.

Expert reviews note that hysteroscopic removal of adhesions can restore menstrual flow and improve pregnancy rates, especially when a reasonable amount of healthy lining remains. At the same time, the presence of dense scars or repeated procedures can lower live birth rates, so clear conversations about expectations and backup plans matter.

Reading Your Report And Talking With Your Team

Ultrasound and related imaging reports can feel packed with jargon. Phrases such as “synechiae,” “intrauterine adhesions,” or “irregular endometrial echo” may all point toward the same picture. If your report hints at asherman’s syndrome on ultrasound, simple questions can help you understand where things stand.

You might ask which parts of the cavity appear scarred, how much healthy lining seems to remain, and whether the radiologist recommends further imaging. Asking whether a saline infusion scan or hysteroscopy would change management can clarify why another procedure is or is not on the table.

This article offers general education only and cannot replace guidance from your own clinician. If you have symptoms such as painful periods, light or absent bleeding, or infertility after uterine surgery, an early visit with a gynecologist or reproductive specialist can help you build a plan that fits your goals.