Venous intravasation during hysterosalpingography

Case contributed by Dr Tamsir Rongpipi

Presentation

Primary infertility, known case of SLE, Married life: 5 years. No history of any previous intervention or surgery.

Patient Data

Age: 35 years
Gender: Female

Right patent Fallopian tube.

Left Fallopian tube could not be demonstrated beyond the corneal portion.

Intravasation of contrast into the myometrial vessels and subsequently into pelvic veins.

Case Discussion

Intravasation on HSG is characterized firstly by opacification of the myometrial vessels (mostly veins) which appears as fine lace-like network or reticular pattern surrounding the uterine cavity and then enters larger pelvic veins.  

Intravasation may indirectly indicate tubal occlusion as it has been postulated that tubal occlusion might be associated with intravasation due to increasing intra-uterine pressure.

Intravasation is one of the pitfalls which can mimic intraperitoneal spillage in an occluded tube.

Another differential diagnosis can be uterine perforation but they usually occur as a result of any intra-uterine procedure or implantation.

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