Intravasation during hysterosalpingography using oil-base contrast medium--a second look

Area of Science:

• Reproductive Medicine
• Diagnostic Imaging
• Gynecologic Procedures

Background:

• Hysterosalpingography (HSG) is a standard imaging technique for evaluating the female upper reproductive tract.
• A known complication of HSG is lymphatic and/or venous intravasation, potentially leading to embolization.
• Understanding the incidence and sequelae of intravasation is crucial for patient safety.

Purpose of the Study:

• To assess the incidence of lymphatic and/or venous intravasation during hysterosalpingography.
• To determine if intravasation or embolization leads to adverse complications.
• To identify factors associated with intravasation and its relationship to upper genital tract pathology.

Main Methods:

• Retrospective analysis of 593 consecutive hysterosalpingograms performed using a low-viscosity oil-based contrast medium.
• Documentation of intravasation and embolization events.
• Correlation of intravasation with patient history and detected upper genital tract abnormalities.

Main Results:

• Intravasation occurred in 41 out of 593 cases (6.9%).
• Embolization was documented in six patients.
• No adverse sequelae were observed in patients experiencing intravasation or embolization.
• Intravasation was frequently associated with upper genital tract pathology, particularly suspected tubal occlusion.

Conclusions:

• Intravasation during hysterosalpingography is a relatively common event but appears to be safe when using low-viscosity oil-based media.
• Proper procedural technique, including appropriate timing and avoiding excessive instillation pressure, can minimize intravasation incidence.
• High-resolution fluoroscopy aids in detecting intravasation, which may be linked to underlying reproductive tract abnormalities.