Oil embolism following hysterosalpingography

Abstract

The purpose of this report is to record another instance of oil embolism, a serious complication, following hysterosalpingography. The procedure is a rather common, and usually benign examination in gynecologic and roentgenologic practice, but it should be remembered that, like intravenous pyelography,3 it is not entirely without danger.A few cases of oil embolism have been published in the American literature,1, 5, 9 but most of the material on this subject has appeared in journals published outside the United States. Cases have been reported in which, following hysterosalpingography, cough and occasionally blood-stained sputum occurred and were attributed to small pulmonary emboli.4, 7, 8 Gajzágó2 reported the death of a 60-year-old woman after hysterosalpingography performed for postmenopausal bleeding. The patient went into shock soon after the injection of Iodipin, at a pressure of 80 mm. of mercury, and died nine hours later. Necropsy revealed oil emboli in the lungs, heart, and kidneys. A submucous fibroid was found in the uterus, and it was concluded that this may have been a causative factor in the intravasation of the oil into the venous circulation.In 1923, Sicard and Forestier6 injected iodized oil into the femoral veins of dogs without harmful effect. The oil reached the pulmonary capillaries, and in ten to twelve minutes had disappeared from them. In other experiments, 2 to 4 c.c. of the oil were injected very slowly into the cubital veins of human subjects. Serial roentgenograms of the chest showed that it reached the pulmonary capillaries within three to four seconds. It remained in the lung in the form of droplets for six to eight minutes, after which it suddenly disappeared. Cough, without dyspnea, was the only untoward symptom noted by the patient.We have seen two cases at the Massachusetts General Hospital in which oil entered the circulatory system following hysterosalpingography, and in neither of them was it possible to demonstrate subjective or objective evidence of a pulmonary lesion. A third case, seen more recently, is presented in detail to illustrate one of the possible dangers which may be encountered following the injection of oil into the uterus.