Question:

Which of the following distinguish uterine venous intravasation from free intraperitoneal spillage of contrast?
1. Intraperitoneal contrast is amorphous and does not demonstrate wash-out.
2. Intravasated contrast accumulate transiently within tubular structures (veins) and is subsequently washed out.
3. Contrast spilled into the peritoneal cavity first passes through the myometrium, producing a lace-like pattern of contrast.
4. Intravasated contrast enters the systemic circulation and will be excreted by the kidneys.
5. Intravasation of contrast is extremely painful for the patient.





Answer:

The correct answers for the question "Which of the following distinguish uterine venous intravasation from free intraperitoneal spillage of contrast?" are:

1. Intraperitoneal contrast is amorphous and does not demonstrate wash-out.

2. Intravasated contrast accumulate transiently within tubular structures (veins) and is subsequently washed out.

3. Contrast spilled into the peritoneal cavity first passes through the myometrium, producing a lace-like pattern of contrast.

4. Intravasated contrast enters the systemic circulation and will be excreted by the kidneys.



Explanation
1-3.  Uterine venous intravasation [is characterized first by the opacification of myometrial vessels which appear as a fine lace-like network surrounding the uterine cavity.  Subsequently the contrast enters larger pelvic veins and is washed out.  This is in contrast to free intraperitoneal contrast spillage, which does not demonstrate these characteristics and, in particular, does not washout.]

4.  [Because intravasated contrast remains within the circulation, renal excretion of contrast is observed on delayed images.  Intraperitoneal contrast persists within the peritoneal cavity and demonstrates negligible renal clearance.]

5.  [The process of venous intravasation generally does not cause acute pain.]



From the manuscript:
Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization.
Radiology Case. 2012 Sep; 6(9):18-22


This article belongs to the OB/GYN section.




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From the manuscript

Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization.

Free full text article: Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization.

Abstract
Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs.






References



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