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Chen M, Huang S, Song C, Chen X, Chen J, Bu G, Zhang H, Huang W, Fu J, Xu E. Value of painless transvaginal four-dimensional hysterosalpingo contrast sonography in reducing venous intravasation: a comparative study. J Ultrasound 2024:10.1007/s40477-023-00847-8. [PMID: 38219240 DOI: 10.1007/s40477-023-00847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/11/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE To investigate the value of painless transvaginal four-dimensional hysterosalpingo contrast sonography (TV 4-D HyCoSy) in reducing venous intravasation and its influencing factors through a retrospective comparative study on conventional TV 4-D HyCoSy. MATERIALS AND METHODS A total of 451 patients were enrolled in this study from Jan. 2019 to Oct. 2021. There were 249 patients in the painless TV 4-D HyCoSy group and 202 patients in the conventional TV 4-D HyCoSy group. The incidence of venous intravasation and its related influencing factors were analyzed and compared between these two groups. The difficulty of image evaluation for the diagnosis was also compared. RESULTS There was no significant difference in the baseline characteristics between the painless group and the conventional group (p > 0.05). Compared with the conventional group, the painless group had a lower incidence of venous intravasation (16.9 vs. 24.8%; p = 0.039). Painless TV 4-D HyCoSy was more effective in reducing venous intravasation in patients with primary infertility (p = 0.032) without a history of pelvic surgery (p = 0.008) or ectopic pregnancy (p = 0.018). Logistic regression analysis demonstrated that painless TV 4-D HyCoSy and endometrial thickness > 5 mm were protective factors for venous intravasation. Moreover, the diagnostic procedure was easier in the painless group than in the conventional group (p = 0.002). CONCLUSIONS Painless TV 4D-HyCoSy may be an effective mode in reducing the incidence of venous intravasation and improving the diagnosis of patency of fallopian tubes.
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Affiliation(s)
- Mengjie Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Shiying Huang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Changlin Song
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Xiaomin Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Jiajia Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Guojuan Bu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Huiying Zhang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Wanling Huang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Juan Fu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China.
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China.
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Ford J, Hince D, Lee E, Lo G. Intravasation complicating hysterosalpingo-foam sonography (HyFoSy) using ExEm® Foam. Aust N Z J Obstet Gynaecol 2023; 63:577-582. [PMID: 37185818 DOI: 10.1111/ajo.13682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Transvaginal hysterosalpingo-foam sonography (HyFoSy) assesses tubal patency in an outpatient setting and without ionising radiation, unlike traditional hysterosalpingography (HSG) under fluoroscopy. Like HSG, HyFoSy may be complicated by uterine intramural contrast leak, leading to venous intravasation. Intravasation of particulate contrast agents risks pulmonary or cerebral emboli. AIMS We aimed to assess the intravasation rate of HyFoSy using ExEm® Foam and association with endometrial thickness, ExEm® Foam volume, uterine length, adenomyosis severity, uterine morphology or pain score. METHODS An ethics-approved retrospective study on all HyFoSy examinations between 23 January 2018 and 27 October 2021 on sub-fertile patients, trying to conceive. Initial transvaginal sonography confirmed anatomy, uterine morphology, adenomyosis severity and endometrial thickness. Subspecialist radiologists performed HyFoSy with sonographer assistance. Intravasation was identified in real time but also checked for afterwards. Patients were asked to rate instillation pain/discomfort from one to ten immediately afterward. RESULTS Four hundred and thirty-six (n = 436) patients met inclusion criteria. Thirty (6.9%) experienced intravasation. Endometrial thickness and pain score were associated with intravasation. For every millimetre increase in endometrial thickness, the odds of intravasation decreased by 26% (P = 0.010). For every point increase on the pain scale, the odds of intravasation increased by 22% (P = 0.032). There was no evidence of an association between instilled ExEm® Foam volume or the other previously published parameters with intravasation. CONCLUSION A 6.9% rate of intravasation was observed. Both endometrial thickness and pain score were significantly associated with intravasation. There was no evidence of an association between ExEm® Foam volume and intravasation.
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Affiliation(s)
- Jemma Ford
- Western Ultrasound For Women, Perth, Western Australia, Australia
- Sir Charles Gairdner Osborne Park Hospital Care Group, Perth, Western Australia, Australia
| | - Dana Hince
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Emmeline Lee
- Western Ultrasound For Women, Perth, Western Australia, Australia
- Sir Charles Gairdner Osborne Park Hospital Care Group, Perth, Western Australia, Australia
| | - Glen Lo
- Western Ultrasound For Women, Perth, Western Australia, Australia
- Sir Charles Gairdner Osborne Park Hospital Care Group, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
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Xu Z, Wang Y, Sun J, Chen S, Yan Z, Lin C, Shu J. Evaluation of tubal patency by hysterosalpingo-contrast Sonography (HyCoSy): Controversies, dilemmas and considerations. Heliyon 2023; 9:e17461. [PMID: 37539233 PMCID: PMC10395035 DOI: 10.1016/j.heliyon.2023.e17461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Evaluation of tubal patency is one of the vital steps in the process of female infertility management. Hysterosalpingo-contrast Sonography (HyCoSy) has become the first-line recommendation for evaluating tubal patency. However, there remain some controversies and dilemmas relevant to the evaluation of tubal patency by HyCosy, with no effective solution has been proposed or no consensus has been reached. Herein, combined with previous research and clinical experience, we conclude and analyze these controversies and dilemmas, aiming at offering our perspective on the opportunities and challenges which are faced by HyCosy.
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Affiliation(s)
- Zining Xu
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yaoting Wang
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Sun
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuangxi Chen
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zou Yan
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chen Lin
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jing Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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4
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Jin BB, Ma Y, Zhao XH, Teng YL, Zhu SY. Risk Factors of Contrast Agent Intravasation With Sulfur Hexafluoride Microbubble During Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1587-1594. [PMID: 36637120 DOI: 10.1002/jum.16179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To analyze the risk factors of sulfur hexafluoride microbubble contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy), and to explore a simple prediction model by the obvious clinical history. METHODS This was a retrospective study included 299 infertility women who had undergone HyCoSy examination from July 1, 2018 to June 31, 2019. The factors were recorded, including age, endometrial thickness, balloon length, infertility type, history of intrauterine surgery, history of pelvic surgery, and tubal patency. The method of multivariate logistic regression analysis was adopted to analyze the risk factors affecting the contrast agent intravasation, and the receiver operating characteristic curves were plotted to test their efficacy. RESULTS Secondary infertility, a history of intrauterine surgery, thin endometrial thickness, and tubal obstruction were all risk factors of the occurrence of intravasation (P < .05). And the area under the receiver operating characteristic curves of the multifactor-combined prediction model of the intravasation was significantly larger than that of single-factor. CONCLUSIONS Sonographers and gynecologists should be familiar with the risk factors of intravasation and select the appropriate timing of HyCoSy toward reducing the occurrence of intravasation and other complications after thoroughly explaining and communicating with the patients.
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Affiliation(s)
- Bin-Bin Jin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Ma
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiu-Hua Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Ling Teng
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shang-Yong Zhu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Devine K, Dolitsky S, Ludwin I, Ludwin A. Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology. Fertil Steril 2022; 118:19-28. [PMID: 35725118 DOI: 10.1016/j.fertnstert.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
The high efficacy of modern assisted reproductive technology (ART) and increase in the number of noninfertile patients who are using ART for family building in the United States call into question the relevance of the standard, one-size-fits-all infertility evaluation. Here, we explore whether all patients presenting for ART need uterine cavity and tubal assessment and what tests are most appropriate, efficient, and cost-effective in current times.
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Affiliation(s)
- Kate Devine
- Division of Reproductive Endocrinology and Infertility, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland; Shady Grove Fertility, Washington, D.C..
| | - Shelley Dolitsky
- Division of Reproductive Endocrinology and Infertility, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland
| | - Inga Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
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6
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Jin Y, Huang W, Qv Q, Liu S. Development of a Nomogram for Predicting Intravasation Before Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography. Int J Womens Health 2022; 14:583-591. [PMID: 35479293 PMCID: PMC9037719 DOI: 10.2147/ijwh.s359467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) may lead to false-negative results in tubal patency evaluation. Although the influencing factors associated with intravasation have been investigated, some factors are only identified during 4D-HyCoSy, thus currently no studies on preventing intravasation. However, several preprocedural features can be collected in advance, which may be valuable in predicting intravasation. Objective The purpose of this study is to establish a nomogram incorporating the preprocedural features to predict the risk of intravasation before TVS 4D-HyCoSy. Methods The data of 276 infertile women with patent fallopian tubes were analyzed retrospectively. They were assigned to the study group (n = 62) and the control group (n = 214) according to the development of intravasation. The preprocedural characteristics were collected to investigate the predictors independently associated with intravasation, which were then served as the construction of a nomogram. The performance of the nomogram was verified internally. Results History of uterine curettage (OR = 2.341, P = 0.009), endometrial thickness (OR = 0.587, P < 0.001), and examination schedule (OR = 0.790, P = 0.024) were found to be the independent influencing factors associated with intravasation. The established nomogram incorporating these preprocedural features was useful for predicting the risk of intravasation prior to 4D-HyCoSy. It yielded net benefits when the predicted probability was less than 50%. Conclusion The nomogram incorporating the preprocedural characteristics achieved a net benefit for clinical decision-making when the estimated risk was less than 50%. It is recommended to change the examination schedule for patients with an estimated risk greater than 50% and perform 4D-HyCoSy when the risk is less than 50%.
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Affiliation(s)
- Yi Jin
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
| | - Wendi Huang
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
| | - Qinhong Qv
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
| | - Shuling Liu
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
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7
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Levaillant JM, Rabourdin A, Pinto M, Hurteloup E, Vernet T, Pasquier M, Moquet PY, Massin N. HyFoSy for Fallopian tube test, the how: Sonographic signs and standardization with a simple classification. J Gynecol Obstet Hum Reprod 2022; 51:102307. [PMID: 34986385 DOI: 10.1016/j.jogoh.2021.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jean-Marc Levaillant
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France; Hôpital Privé Armand Brillard, Groupe Ramsay Générale de Santé, Nogent-sur-Marne, France; Clinique la Sagesse, Rennes, France
| | - Anaïs Rabourdin
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Mélodie Pinto
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Edwige Hurteloup
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Thibaut Vernet
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | - Maud Pasquier
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France
| | | | - Nathalie Massin
- Department of Obstetrics, Gynecology and Reproductive Medecine, Intercommunal Hospital, University Paris Est, Créteil, France.
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8
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AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:E39-E45. [PMID: 33665889 DOI: 10.1002/jum.15670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
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9
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Welie NV, Ludwin A, Martins WP, Mijatovic V, Dreyer K. Tubal Flushing Treatment for Unexplained Infertility. Semin Reprod Med 2020; 38:74-86. [PMID: 33339062 DOI: 10.1055/s-0040-1721720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tubal patency testing was initially introduced as a diagnostic test. However, it has been observed that some tubal patency tests also have a therapeutic effect. This therapeutic effect can be influenced by the contrast medium used during tubal flushing. In this review, we discuss current evidence associated with different methods for tubal flushing and their potential impact on reproductive outcomes in women with unexplained infertility. Furthermore, we discuss their diagnostic accuracy, safety, and cost-effectiveness.
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Affiliation(s)
- Nienke van Welie
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin and Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed, Private Hospital and Clinic, Krakow, Poland
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Reproductive Medicine, SEMEAR fertilidade, Ribeirao Preto/SP, Brazil
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Yu X, Yang Y, Li J. Application of ultrasound in the diagnosis of gastrointestinal tumors. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220961194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal tumors are common tumors in the digestive system. Early diagnosis of gastrointestinal tumors is the key to improve prognosis and curative effect of patients with tumors. Compared with other methods of examination and diagnosis, ultrasound examination has the advantages of simple operation, non-invasive, economical, and repeatable operation. With the advancement of ultrasound technology and the development of ultrasound contrast agents, ultrasound examination is more and more applied to gastrointestinal examination. Ultrasound cannot only observe the gastrointestinal wall, but also evaluate the surrounding lesions and metastases, as well as preoperative analysis and postoperative follow-up of gastrointestinal tumors. We reviewed the diagnostic applications of ultrasound in gastrointestinal tumors.
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Affiliation(s)
- XianZhe Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
| | - YanNi Yang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
| | - JianGuo Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China
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11
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Ludwin A, Ludwin I, Szczeklik W, Martins WP. Cutaneous small-vessel vasculitis following hysterosalpingo-foam sonography (HyFoSy). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:831-834. [PMID: 31219636 DOI: 10.1002/uog.20372] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
We present a case of diffuse skin immune reaction, diagnosed as cutaneous small-vessel vasculitis, following assessment of tubal patency by contrast ultrasound, which appears to be the first reported case of hypersensitivity reaction to sonographic tubal patency testing, based on a literature search. A 32-year-old woman presented with non-thrombocytopenic palpable purpura the day after assessment of tubal patency by two-/three-dimensional hysterosalpingo-foam sonography (HyFoSy) using ExEm® Foam. During real-time ultrasound, the observer identified flow in only the right tube when using saline with air as contrast medium; however, the same observer identified flow in both tubes after injecting ExEm Foam and the woman left the clinic without any complications. The next day, the patient was admitted with a complaint of a red-purple skin rash noticed the same morning, associated with moderate leg pain. Slow-motion analysis of the recorded videos and three-dimensional ultrasound datasets showed previously unnoticed venous intravasation of ExEm Foam into the myometrial vessels. Palpable purpura is typically found in vasculitis as a result of extravasation of red cells outside the inflamed blood vessel. This previously unreported side effect of tubal patency testing by HyFoSy, its potential rare organ consequences, as well as unknown consequences of venous intravasation by foam, should be included in the informed consent prior to the examination. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - W Szczeklik
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
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12
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Shi J, Li S, Wu H, He Y, Yi W, Xu J, Liu H, Guan Y. The Influencing Factors of Venous Intravasation During Transvaginal Four-dimensional Hysterosalpingo-contrast Sonography With SonoVue. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2273-2280. [PMID: 31201020 DOI: 10.1016/j.ultrasmedbio.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Transvaginal 4-D hysterosalpingo-contrast sonography with SonoVue (TV 4-D HyCoSy) is the preferred imaging method for evaluating tubal patency. However, venous intravasation in 4-D HyCoSy may affect the diagnosis of tubal patency. The objective of this study was to analyze influencing factors of venous intravasation during TV 4-D HyCoSy. This study included 643 infertile patients who underwent TV 4-D HyCoSy. We analyzed the relationship between the incidence of venous intravasation and patients' basic clinical data, endometrial thickness, inspection timing (clean day of menstruation) and tubal patency. A total of 169 (26.28%) patients exhibited intravasation during TV 4-D HyCoSy. The following are risk factors for venous intravation: secondary infertility, type C + C, type B + C and type B + B in bilateral fallopian tubal patency grouping; endometrial thickness ≤5.45 mm; and taking TV 4-D HyCoSy after menstruation ≤6 d. Infertility duration, intrauterine lesions, a history of pelvic inflammatory disease and a history of pelvic surgery were uncorrelated with venous intravasation. To reduce the incidence of venous intravasation, TV 4-D HyCoSy should be performed 7-10 d after menstruation or when endometrial thickness is thicker than 5.45 mm.
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Affiliation(s)
- Jiayao Shi
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Sushu Li
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Haorong Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Yanni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Wenhong Yi
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Jingjiao Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Hongmei Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China.
| | - Ying Guan
- Department of Biostastics, Southern Medical University, Guangzhou, Guangdong, P.R. China
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13
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He Y, Wu H, Xiong R, Liu H, Shi J, Xu J, Zhang N, Liu Y. Intravasation Affects the Diagnostic Image Quality of Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography With SonoVue. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2169-2180. [PMID: 30597629 DOI: 10.1002/jum.14914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aim to retrospectively analyze the diagnostic image quality of transvaginal 4-dimensional hysterosalpingo-contrast sonography from infertile patients and determine the significant influencing factors. METHODS A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2-dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality. RESULTS Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4-dimensional hysterosalpingo-contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non-cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality. CONCLUSIONS In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.
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Affiliation(s)
- Yanni He
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Haorong Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Ran Xiong
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Hongmei Liu
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Jiayao Shi
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Jingjiao Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Ning Zhang
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Yu Liu
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
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14
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Exalto N, Emanuel MH. Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4827376. [PMID: 31360713 PMCID: PMC6644241 DOI: 10.1155/2019/4827376] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/04/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Tubal patency testing is an essential part of female subfertility evaluation. Traditionally, hysterosalpingography (HSG) was the first step to evaluate tubal patency. However, during the past decade Hysterosalpingo-Contrast Sonography (HyCoSy) was introduced in order to avoid radiation exposure and Hysterosalpingo-Foam Sonography (HyFoSy) has been developed as a safe and less painful alternative. OBJECTIVES AND RATIONALE The aim of this narrative review is to provide an overview of the currently available HyFoSy literature and related clinical aspects. SEARCH METHODS A literature search was conducted using PubMed and Embase from the introduction of HyFoSy to March 2019. Unfortunately, a meta-analysis was not possible due to a too small number of studies, being mutually incomparable for the various subjects of clinical aspects, even for the reliability as a test for tubal patency. OUTCOMES Nine small studies concluded that the accuracy and effectiveness as a test for tubal patency of 2D- and 3D-HyFoSy are comparable or even better than HSG or HyCoSy. With or without using Doppler techniques, 3D-HyFoSy does not seem to offer benefits above real-time 2D-HyFoSy. Five studies reported on pain and discomfort during HyFoSy, concluding that HyFoSy is a well-tolerated, less painful procedure compared to HSG, without a need for the use of analgesics. There are suggestions about an increased pregnancy rate in the first three cycles after the procedure but in no studies pregnancy outcome after HyFoSy was compared with other or no intervention. WIDER IMPLICATIONS HyFoSy is a promising and safe alternative for HSG with regard to accuracy and effectiveness. HyFoSy lacks radiation and iodine exposure and is a well-tolerated and less painful procedure than HSG, without the need for analgesics. However more research is needed to make clear statements regarding a therapeutic effect of HyFoSy.
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Affiliation(s)
- Niek Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Mark Hans Emanuel
- Division of Woman and Baby, Department of Gynaecology and Reproductive Medicine, University Medical Centre, Utrecht, Netherlands
- Department of (Uro)gynaecology, University Hospital, Ghent, Belgium
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15
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Wang W, Zhou Q, Zhou X, Chen Z, Zhang H. Influence Factors on Contrast Agent Venous Intravasation During Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2379-2385. [PMID: 29637586 DOI: 10.1002/jum.14594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To explore the risk factors on contrast agent venous intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy). METHODS The TVS 4D-HyCoSy imaging data were collected from 276 female infertile patients. The correlation between endometrial thickness, days after menstruation, intrauterine intervention history, fallopian tubal patency degree, and contrast agent venous intravasation, respectively, was analyzed. RESULTS In our study, the incidence of contrast agent venous intravasation was 13.04%. Endometrial thickness and days after menstruation were significantly associated with venous intravasation (P < .05). However, there was no significance for intrauterine intervention history and fallopian tube patency degree. CONCLUSIONS Contrast agent intravasation during TVS 4D-HyCoSy is not infrequent. Performing TVS 4D-HyCoSy according to endometrial thickness and menstrual period could reduce intravasation incidence to some extent.
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Affiliation(s)
- Weiqun Wang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiulan Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xingxing Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hui Zhang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Ludwin I, Martins WP, Nastri CO, Ludwin A. Pain Intensity During Ultrasound Assessment of Uterine Cavity and Tubal Patency With and Without Painkillers: Prospective Observational Study. J Minim Invasive Gynecol 2017; 24:599-608. [DOI: 10.1016/j.jmig.2017.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/08/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
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