Presentation
Primary infertility without previous surgery.
Patient Data
Bilateral obstruction of the fallopian tubes has been observed, with the tubes failing to extend beyond the cornual region. No free peritoneal contrast spill.
A web-like pattern of opacity is visible around the uterine cavity, suggesting that the contrast agent has entered the blood vessels within the uterine muscle layer and reached the pelvic veins.
Case Discussion
Venous intravasation refers to the passage of contrast media into the veins, which can occur due to local or systemic abnormalities. In this case, the intravasation may indirectly indicate tubal occlusion.
Tubal occlusion can lead to increased intrauterine pressure that allows the contrast agent to pass into the uterine blood vessels. On imaging, the intravasation creates a reticular pattern and multiple thin lines around the uterine cavity.
On hysterosalpingography, this venous intravasation may lead to a false assumption of intraperitoneal spillage, and care should be taken not to misinterpret the findings.
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