Objective: It was aimed at carrying out a comparative study between three dimensional transvaginal ultrasonography and hysteroscopy in the accuracy of detecting intrauterine cavitary lesions. Study design: Three dimensional transvaginal ultrasonography was done followed by hysteroscopy for all cases (number=50). Data obtained were compared and analyzed to estimate the accuracy of 3D transvaginal ultrasound. Results: The comparison with using Hysteroscopy, the sensitivity, specificity, positive predictive value, negative predictive values and total overall accuracy of Three dimensional transvaginal ultrasonography for total abnormal findings were 89.13%, 100%, 100%, 44.44% and 90% respectively. Conclusion: The three dimensional transvaginal ultrasound is a sensitive method to evaluate the endometrial cavity lesions or abnormalities, before resorting to invasive procedures such as diagnostic hysteroscopy. But hysteroscopy allows direct visualization of the uterine cavity so it can detect small intrauterine lesions which could be missed by vaginal ultrasound.