The aim of this audit is to review the Hysterosalpingography (HSG) service, focussing on determining intravasation prevalence to inform safer procedures and minimise associated complications for future practice. Additional analysis of cannulation success and definitive results are collated to further evaluate the diagnostic capabilities of HSGs and its current efficacy in clinical practice.

Intravasation on HSG is defined by the flow of injected contrast from the uterine cavity into adjacent myometrial vessels (usually the veins).[1] Intravasation events can affect safe usage of contrast mediums in HSGs and have implications on periprocedural symptoms for patients. Additionally, severe intravasation can cause an image artefact, obscuring tubal filling and affecting the diagnostic quality of HSGs.[2][Fig 1][Fig 2][Fig 3] A novel classification system has been proposed in 2013 to grade intravasation severity based on regional spread; however, no standardized grading prevails in...

Of the 315 HSGs, 97% (n=306) demonstrated definitive results. Cannulation success was achieved in 98% (n=308) of studies with all (n=7) failed cases due to cervical stenosis. Most of the HSG’s performed were WSCM (99%, n=311) with 4 cases of OSCM performed. An intravasation rate of 7% was identified. The majority (73%, n=16) were classified as grade 1, with 9% (n=2) and 18% (n=4) of cases classified as grade 2 and 3 respectively.[Fig 4] Within the severe grade 3 intravasation events, 3 cases (75%) obscured...

HSG remains a sensitive investigation for the assessment of tubal patency. However, potential under-reporting of intravasation poses an increased risk to patients given the rapid clinical uptake of oil-soluble contrast mediums (OSCM). This emphasizes a need for further education of radiologists and warrants precautionary alterations to practice. A proposition to utilise WSCM prior to OSCM is recommended to mitigate the risk of oil intravasation and improve safety in future practice. Furthermore, standardized classification can provide interpretational consistency and should be considered to improve reporting accuracy...

Bhoil R, Sood D, Sharma T, Sood S, Sharma J, Kumar N, et al. Contrast Intravasation During Hysterosalpingography. Pol J Radiol [Internet]. 2016 May 17;81:236–9. Available from: https://pubmed.ncbi.nlm.nih.gov/27279925 Deftereos SP, Balomenos V, Frigkas K, Stylianou C, Foutzitzi S. Venous Intravasation During Hysterosalpingography. Cureus. 2021 Dec;13(12):e20489. Dusak A, Soydinc HE, Onder H, Ekinci F, Görük NY, Hamidi C, et al. Venous intravasation as a complication and potential pitfall during hysterosalpingography: re-emerging study with a novel classification. J Clin Imaging Sci [Internet]. 2013 Dec 31;3:67. Available from:...