Venous-lymphatic intravasation during hysterosalpingography using hydrosoluble contrast medium: A technique with no complications

Abstract The aim of this article is to assess the incidence of venous/lymphatic intravasation during hysterosalpingography (HSG), using iodinated non-ionic hydrosoluble contrast media, and the consequences that this condition involves. We have considered the major complications following intravasation; 1395 HSG performed in 9 years at our institute have been examined. The examination was performed through the application of exo-cervical cups or intracavitary Sholkoff catheters, injecting an average of 6 mL of non-ionic hydrosoluble contrast medium, with an iodine concentration of 320 to 370 mg I/mL. HSG was performed with digital equipment, under fluoroscopic control. We observed in 14 of 1395 patients (1%), 19 cases of intravasation; among them, 11 were venous (5 bilateral, 6 monolateral) and 3 were lymphatic (monolateral). Seven of fourteen patients presented HSG alterations of the tubal patency, represented by hydrosalpinx (4 patients, 5 tubes), monolateral tubal occlusion (1 patient, 1 case), bilateral tubal occlusion (1 patient, 2 cases), 1 case of monolateral salpingectomy, 1 case of Asherman's syndrome, and a mullerian malformation as the bicornuate uterus (1 case). Two patients showed concomitance of two alterations. 567 patients with alterations of the uterine/tubal patency did not report lymphatic-venous vessels intravasation or major complications. No patient with intravasation presented pulmonary or cerebral complications, or pelvic vessels thrombosis or late pelvic inflammatory disease. The venous/lymphatic opacification during HSG, using iodinated non-ionic hydrosoluble contrast media, does not represent a complication of the examination, because it is not linked to major complications. This event is not associated to predisposing anatomic conditions, such as tubal occlusion or endometrial-myometrial inflammation.