Hysterosalpingography is a study performed commonly to assess the upper reproductive tract in infertile women. A risk with hysterosalpingography is either lymphatic and/or venous intravasation with or without embolization. Of 593 consecutive hysterosalpingograms performed with a low-viscosity oil-base medium, intravasation occurred in 41 cases (6.9%). Embolization was documented in six patients. There were no recognized adverse sequelae from either intravasation or embolization. Intravasation was frequently associated with pathology of the upper genital tract, and suspected tubal occlusion was the most common abnormality detected. Proper timing of the procedure and avoidance of excessive instillation pressure will diminish the incidence of this complication. The use of both a low-viscosity oil-base medium and high-resolution fluoroscopic image intensification may increase the detection of intravasation.
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Article Synopsis
- Intravasation during hysterosalpingograms (HSGs) refers to the leakage of contrast from the uterus into surrounding blood vessels, posing risks like pulmonary and cerebral embolisms, with prevalence rates varying from 0.0% to 13%, especially higher with oil-soluble contrast media (OSCM).
- A study was conducted over two years in a public teaching hospital in Western Australia to analyze the occurrence and grading of intravasation in HSGs, using blinded assessments for accuracy.
- The findings revealed a 7.1% intravasation rate, with only 45% reported and 32% graded, highlighting significant under-reporting and the need for standardized classification to enhance radiologist oversight and improve patient
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