Intravasation on Hysterosalpingography

Intravasation refers to backflow of injected contrast into the venous or lymphatic circulation. Venous intravasation is harmless with water-soluble contrast; however, oil-based contrast media can cause fat emboli with venous intravasation.

Images of early intravasation reveal filling of multiple, thin, beaded channels, with lymphatic intravasation said to appear as finer vessels compared to lymphatics. Continued pressure results in opacification of veins as tubular structures (white arrow) that wash out when injection stops.

Intravasation can be seen in normal patients, as well as in those with recent uterine surgery or increased intrauterine pressure because of tubal obstruction. The image above shows a case of lymphatic intravasation in a patient with bilateral tubal obstruction and dilatation.

References

• Fisher MS. Lymphangiogram following hysterosalpingography. Am J Roentgenol Radium Ther Nucl Med. 1966 Sep;98(1):233-5.
• Hipona FA, Ditchek T. Uterine lymphogram following hysterosalpingography. Am J Roentgenol Radium Ther Nucl Med. 1966 Sep;98(1):236-8.
• Ubeda B, Paraira M, Alert E, Abuin RA. Hysterosalpingography: spectrum of normal variants and nonpathologic findings. AJR Am J Roentgenol. 2001 Jul;177(1):131-5.