86 Chapter 5 Additionally, there were 197 cases of intravasation after an HSG with the use of oil-based contrast in the case reports/series. In 22 of these women this led to the formation of an oil embolism (22/197, 11.2%). Four of these women were asymptomatic, 18 were symptomatic. Symptoms included a transient cough and/or dyspnoea and neurological symptoms. Four cases were described of women with serious consequences of an oil embolism (Table 1) (11, 30, 33, 41). Table 1. Characteristics of serious consequences of oil embolism after HSG Study Contrast Risk factors Organ system involved Consequences Flew, 1944 (30) Lipiodol (not specified) HSG on day 24 of menstrual cycle; use of fluoroscopy not reported Pulmonary and cerebrum Hemiplegia, survived Charawanamuttu et al, 1973 (33) Lipiodol Ultra Fluid >20ml of contrast, poor definition of fluoroscopy images Pulmonary and retina 3 months of impaired vision Dan et al., 1990 (41) Lipiodol Ultra Fluid Use of fluoroscopy not reported Pulmonary, central nervous system Comatose for 11 days, afterwards normal mental/motor function Uzun et al., 2004 (11) Lipiodol (not specified) Use of fluoroscopy not reported Pulmonary, central nervous system Comatose for 10 days, afterwards mental/ motor function progressively improved HSG = hysterosalpingography When including only the studies (including the case reports) that used fluoroscopy screening, there were 250 women with intravasation after an HSG with the use of oilbased contrast. In this group there were 16 women with oil embolisms (16/250, 6.4%), of which two had symptoms of coughing and one temporary impaired vision as a result of a retinal oil embolism (3/16, 18.8%). The authors reported that the fluoroscopy images were of poor quality, and over 20 ml of contrast was used during this last procedure (30). When excluding the studies with known fluoroscopy guidance, there were 611 women with intravasation after an HSG with the use of oil-based contrast. In this group there were 24 women with oil embolisms (24/611, 3.9%), of which 19 (19/24, 79.2%) had, mostly transient, pulmonary symptoms. Of the 24 women with oil embolisms there
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