Venous Intravasation (Hysterosalpingography)
Venous intravasation during hysterosalpingography occurs when contrast medium enters the uterine venous plexus due to increased intrauterine pressure or disruption of the endometrial barrier. It is most commonly encountered in patients with recent uterine instrumentation, endometritis, cervical stenosis, or forceful contrast injection. Recognition of this entity is important to avoid misinterpretation as tubal opacification or peritoneal spill (Fig. 1).
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| Fig-1 |
Findings: Early opacification of multiple linear and tubular vascular channels radiating from the uterine cavity is seen. The pattern follows the expected course of uterine veins rather than fallopian tubes.
Conclusion: Imaging features are diagnostic of venous intravasation during hysterosalpingography.
Patient Symptoms
Patients may experience acute pelvic pain or cramping at the time of injection. Venous intravasation itself is usually transient and resolves without sequelae. Many patients have a history of recent uterine surgery, curettage, or pelvic inflammation.
Procedure (Hysterosalpingography)
The examination is performed in the early proliferative phase of the menstrual cycle. Under aseptic precautions, a cervical cannula or balloon catheter is inserted. Contrast is injected slowly under fluoroscopic guidance. On visualization of venous filling, injection should be immediately slowed or discontinued.
Contrast Medium & Administration
A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used with the patient in the lithotomy position. Total contrast volume typically does not exceed 6–10 mL. Low-pressure, incremental injection is essential to prevent venous intravasation.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Uterine tenaculum (if required)
- Leech–Wilkinson cannula
- Rubin cannula
- Balloon HSG catheter
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Only water-soluble contrast media should be used to minimize the risk of embolic complications. Injection must be gentle and immediately stopped if venous filling is identified. Pregnancy and active pelvic infection must be excluded prior to the study.
Related Conditions
Venous intravasation may be associated with endometritis, post-myomectomy scarring, recent dilation and curettage, cervical stenosis, and adenomyosis. Differentiation from tubal patency is based on early appearance, vascular configuration, and lack of peritoneal spill.
Declaration
This case is presented for educational purposes only. Patient identity has been anonymized, and no personally identifiable information is disclosed.
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