Contrast Intravasation During Hysterosalpingography

Bhoil, Rohit; Sood, Dinesh; Sharma, Tanupriya; Sood, Shilpa; Sharma, Jai Bharat; Kumar, Nitesh; Ahluwalia, Ajay; Parekh, Dipen J.; Mistry, Kewal; Sood, Saurav

doi:10.12659/pjr.896103

Cited by 24 publications

(29 citation statements)

References 7 publications

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“…It may be related to predisposing factors altering endometrial vascularity and permeability. Bhoil et al reported an increased risk of intravasation during HSG in women with certain clinical conditions like nonspecific pelvic pain, menometrorrhagia, secondary infertility, ectopic pregnancy, polycystic ovarian disease, endometriosis, hydatidiform mole, vaginal itching, and subclinical urinary infections. Nevertheless, it may be seen in patients with no abnormalities, as well as in those with a history of recent uterine surgery or increased intrauterine pressure due to tubal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Intravasation Affects the Diagnostic Image Quality of Transvaginal 4‐Dimensional Hysterosalpingo‐Contrast Sonography With SonoVue

Xiong

et al. 2018

J of Ultrasound Medicine

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Objectives We aim to retrospectively analyze the diagnostic image quality of transvaginal 4‐dimensional hysterosalpingo‐contrast sonography from infertile patients and determine the significant influencing factors. Methods A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2‐dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality. Results Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4‐dimensional hysterosalpingo‐contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non–cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality. Conclusions In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.

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Section: Discussionmentioning

confidence: 99%

Intravasation Affects the Diagnostic Image Quality of Transvaginal 4‐Dimensional Hysterosalpingo‐Contrast Sonography With SonoVue

Xiong

et al. 2018

J of Ultrasound Medicine

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“…The most frequently mentioned are performance of the procedure during the early postmenstrual and late preovulatory periods; the presence of Mullerian duct anomalies; pelvic discomfort and unusual lingering pain during HSG; menometrorrhagia; polycystic ovary syndrome; endometriosis; uterine malformations related to secondary infertility, recurrent miscarriages, endometrial injury, complicated delivery, and Asherman's syndrome; and subclinical urinary infections. 6,7 No consensus has been reached regarding the role of high pressure in the uterine cavity during HSG. Our hypothesis assumes that a main cause of the green urine sign following intravasation is the short-lasting increase in pressure in the uterine cavity during chromopertubation.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 This is almost four times higher than the frequency during HSG. 6 – 8 The following question thus arises: What is the difference in the frequency of occurrence of intravasation in otherwise similar procedures?…”

Section: Discussionmentioning

confidence: 99%

“…By eliminating predisposing factors, it is possible to minimise or prevent intravasation and reduce its potential consequences. 6 – 9 , 12 – 14 Therefore, we treat the green urine sign as a complication of laparoscopic chromopertubation.…”

Section: Discussionmentioning

confidence: 99%

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Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

et al. 2020

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Tubal diseases are responsible for 25% to 35% of female infertility. Laparoscopic chromopertubation is the gold standard for assessing tubal patency when female infertility is suspected. Intravasation is a complication of intrauterine procedures involving the passage of fluid filling the uterine cavity into the bloodstream through endometrial vessels (from the myometrial veins to the uterine venous plexuses). This complication has been described during hysterosalpingography and sonohysterosalpingography. We herein present a report of three cases in which severe intravasation occurred during laparoscopic chromopertubation using methylene blue as a contrast agent. The intravasation manifested as green urine (i.e., the “green urine sign”). The presence of methylene blue in the urine and blood was confirmed by laboratory tests. All three patients had risk factors for intravasation as described in the literature (unilateral or bilateral tubal obstruction, endometriosis, and previous intrauterine procedures for Mullerian duct anomalies and Asherman’s syndrome). The green urine sign appeared a few hours after laparoscopic chromopertubation and spontaneously resolved after 24 hours. Cystoscopy was performed to rule out bladder injury. All three patients required only clinical observation.

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Risk Factors of Contrast Agent Intravasation With Sulfur Hexafluoride Microbubble During Hysterosalpingo‐Contrast Sonography

Jin

Zhao

et al. 2023

J of Ultrasound Medicine

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Objectives To analyze the risk factors of sulfur hexafluoride microbubble contrast agent intravasation during hysterosalpingo‐contrast sonography (HyCoSy), and to explore a simple prediction model by the obvious clinical history. Methods This was a retrospective study included 299 infertility women who had undergone HyCoSy examination from July 1, 2018 to June 31, 2019. The factors were recorded, including age, endometrial thickness, balloon length, infertility type, history of intrauterine surgery, history of pelvic surgery, and tubal patency. The method of multivariate logistic regression analysis was adopted to analyze the risk factors affecting the contrast agent intravasation, and the receiver operating characteristic curves were plotted to test their efficacy. Results Secondary infertility, a history of intrauterine surgery, thin endometrial thickness, and tubal obstruction were all risk factors of the occurrence of intravasation (P < .05). And the area under the receiver operating characteristic curves of the multifactor‐combined prediction model of the intravasation was significantly larger than that of single‐factor. Conclusions Sonographers and gynecologists should be familiar with the risk factors of intravasation and select the appropriate timing of HyCoSy toward reducing the occurrence of intravasation and other complications after thoroughly explaining and communicating with the patients.

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Contrast Intravasation During Hysterosalpingography

Cited by 24 publications

References 7 publications

Intravasation Affects the Diagnostic Image Quality of Transvaginal 4‐Dimensional Hysterosalpingo‐Contrast Sonography With SonoVue

Intravasation Affects the Diagnostic Image Quality of Transvaginal 4‐Dimensional Hysterosalpingo‐Contrast Sonography With SonoVue

Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

Risk Factors of Contrast Agent Intravasation With Sulfur Hexafluoride Microbubble During Hysterosalpingo‐Contrast Sonography

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