Background: Three-dimensional sonographic technology has gained increased acceptance in clinical practice. This technique involves the gathering of a large amount of data and the quick reconstruction of pictures in the coronal, sagittal and transverse planes. The purpose of this work was to compare the diagnostic accuracy of the three-dimensional trans vaginal ultra-sonographic (3-DTVUS) and hysteroscopy in the detection of cavitary lesions in the uterus. Methods: This study was comparative cross-sectional and included 60 patients who had 2D ultrasonography or hysterosalpingography for suspected intrauterine abnormalities. Each patient underwent a thorough history taking, clinical assessment, investigations, imaging [2D transvaginal ultrasound and 3D vaginal ultrasound] and hysteroscopy. Results: 3DTVUS had a (95%) sensitivity in detecting uterine abnormalities compared to hysteroscopic examination. Also, the specificity was (88%) which indicates that only (12%) of the truly negative cases will be missed. The positive predictive values (PPV) of 3D TVUS were (99%) with an accuracy of (94%). The lowest parameter calculated was the negative predictive value (NPV) (58%). 3DTVUS had a specificity and PPV of 100% regarding the detection of all of the mentioned uterine abnormalities. Furthermore, the sensitivity was 100% for all abnormalities except the polyps and adhesions which were 91% and 67% respectively. The NPV was 100% for all abnormalities except for the polys and intrauterine adhesions (IUAs) which recorded 97%. Finally, the accuracy of 3DTVUS in comparison to hysteroscopy was 100% for all intrauterine abnormalities except the polyps and IUAS which were 98% and 97% respectively. Conclusions: 3DTVUS can be utilized in diagnosing focal lesions of the uterus with comparable outcomes to hysteroscopy.