Lipiodol Granuloma in Fallopian Tubes Localized by Intra-uterine Diodrast Injection, with Special Reference to the Value of Follow-up X-ray Films

Abstract

LIPIODOL has been used in conjunction with the x-rays as a diagnostic test of tubal patency since the report of C. Heuser (1), in 1924. Its radiopacity was first appreciated by Sicard and Forestier (2), who recommended this iodine oil compound for general diagnostic adoption, in 1922. The literature contains numerous reports in which excellent radiographic films are reproduced showing shadows of lipiodol within the tube lumen as well as the “spill” into the peritoneal cavity. However, in gynecology, especially in the investigation of sterility, a number of reports of the last ten years has brought to light certain undesirable sequelæ which are generally overlooked and perhaps under-emphasized. The purpose of the present communication is to call attention to one of these sequelæ, namely, the persistent retention of lipiodol within the fallopian tubes and to the need of taking follow-up films in such cases. In a previous paper (3) I have reported a follow-up of 43 patients who gave a history of having had an intra-uterine injection of lipiodol. In 22 of these, a skia-gram of the pelvis was subsequently available. Fifteen of the 22 showed some lipiodol residue. In the same paper reference was made to Rabbiner's (4) report of contrast media in the pelvis demonstrated by an x-ray plate which was taken in four cases several weeks and months after lipiodol injection. Since then an opportunity has presented itself of studying the films in five additional instances. They were taken from an unselected group of 31 cases, in 26 of which for various reasons a film was not obtained. Lipiodol residue was present in three of the five cases for from one month to a year after the injection. Whether and to what extent deposits of lipiodol may have been encountered in the 26 cases not controlled later by an x-ray plate, is purely conjectural. Opacities found after intervals of more than a year may be so reduced in size as to be confused with phleboliths or small ureteral calculi. In a recent case lipiodol residue was found scattered in the pelvis four years after the injection. Although the presence of post-injection opacities may not be of further significance than perhaps to suggest the presence of peritoneal cysts or adhesions surrounding the oil globules, the presence of foreign body granuloma within the tube lumen which results from persistent irritation of the retained oil is of greater clinical importance. This applies particularly in a patient who has been investigated by lipiodol for sterility and whose tubes were only partially obstructed. I have reported three such instances of tubal blockade due to lipiodol residue, in the communication mentioned above, and subsequently, met with several additional cases. These corroborate the earlier report by E. Ries (5), which dealt with foreign body reaction induced by lipiodol in the tubes.