Anaphylactoid Reaction to Iopamiro (After Pretreatment)

A patient is described with a past history of an anaphylactoid reaction to contrast media who reacted to nonionic contrast media after pretreatment with antihistamines and steroids. The available options to reduce the incidence of reactions include use of non-ionic contrast which has a reported lower frequency than ionic contrast¹⁵ or some form of pretreatment. Various forms of pretreatment have been described and in the majority steroids and antihistamines are used. We describe a patient who reacted to nonionic contrast after a pretreatment regime.     

含碘非离子型造影剂致心包积液一例并文献复习

目的：报道一例含碘非离子型造影剂所致心包积液的个案,通过查阅文献,探讨本例含碘造影剂过敏的发生机制。方法：分析本例患者的临床病例资料及诊治过程,并复习相关文献。结果：本例患者含碘造影剂过敏致心包积液,经治疗后恢复。结论：含碘造影剂过敏考虑IgE介导相关可能。     

Nephrogenic systemic fibrosis and the role of gadolinium contrast media

Nephrogenic system fibrosis is a rare disease affecting patients with severe renal insufficiency or dialysis. Its aetiology is incompletely understood. Evidence is growing that gadolinium contrast media is a major risk factor, whereby risk increases with larger cumulative doses. The role of other risk factors, such as inflammation or electrolyte disturbances, is less clear. All published cases to date received gadodiamide, gadopentetate or gadoversetamide, which are considered to be less stable due to a linear molecular structure. The aetiological significance of stability differences between the non-ionic linear, ionic linear and macrocyclic agents remains to be shown. For prevention, strict indications for MRI in risk patients can be combined with Food and Drug Administration (FDA) or European Medicines Agency (EMEA) guidelines. These recommend checking for renal impairment by history or laboratory tests. The FDA recommends avoidance of all gadolinium contrast media in patients with renal insufficiency grades 4 and 5 (glomerular filtration rate <30 mL/min per 1.73 m(2)) or any grade of acute renal failure in liver transplantation patients or candidates. The EMEA differentiates between agents and advises avoidance of only gadodiamide and gadopentetate in the same patient categories. Other gadolinium contrast media should only be used after careful consideration of risks versus benefits. Post-procedural haemodialysis is only indicated in patients on regular dialysis.     

A contrast technique to improve sampling in cavitating lung lesions

Twelve patients with cavitating lung lesions of uncertain aetiology, who had percutaneous aspiration combined with the instillation of radiographic contrast media, are presented. A diagnosis was made in 11 of the 12 patients (92%). A positive culture was obtained in all patients already receiving treatment for lung abscesses. Cultures of lavage fluid were positive in 89% of infected cavities. The instillation of radiographic contrast media into the lung cavity assists biopsy of the cavity wall, can be used to lavage the cavity, and may facilitate expectoration of sputum.     

Corticosteroid prophylaxis for patients receiving intravascular contrast agents: A survey of current practice in Australia and New Zealand

A survey was made of the use of corticosteroid prophylaxis in patients receiving intravascular contrast media. The replies of 807 respondents were available for analysis and they indicate that such a strategy is common for‘high-risk’patients (62.4%), but very few respondents use corticosteroid prophylaxis for all patients (0.74%).     

Acute contrast reaction management by radiologists: A local audit study

Consultant radiologists and trainees must possess knowledge of optimal acute management of anaphylactic/anaphylactoid contrast reactions because patient survival depends upon prompt initial management. The aim of the present study is to assess the knowledge of first‐line management of these reactions among radiologists. Within one working day, and without prior knowledge, radiology consultants and trainees within four teaching hospitals in a major Australian capital city were asked to complete a confidential questionnaire regarding acute resuscitation management. Scenarios were presented of an adult who developed life‐threatening symptoms of anaphylaxis immediately after intravenous contrast administration, ventricular fibrillation and profound bradycardia. Questions were asked with regards to adrenaline, corticosteroid, antihistamines, intravenous volume expansion, cardio‐pulmonary rescuscitation and knowledge of the emergency telephone number. Sites were assessed for presence of an anaphylaxis management chart and also when each participant last completed a resuscitation course. Forty‐two participants were recruited. Overall, 53% of questions were answered correctly. Only 43% knew the adrenaline dose and if an incorrect dose was administered it was more likely to be an overdose. Notable inadequacies were also discovered with corticosteroid, atropine, antihistamine doses and intravenous fluid use. Only 26% had completed a resuscitation course in the past 2 years. Forty‐five percent knew the emergency telephone number and 55% of rooms using intravenous contrast contained an immediately visible chart for contrast reaction management. Radiologist and trainee knowledge of immediate life‐threatening contrast reaction management is deficient. Severe contrast reactions are uncommon with today's use of non‐ionic contrast, but they still occur. Experience in the management of anaphylaxis can only come from regular, compulsory training.     

Comparison of Urograms using Ionic Contrast,Non-Ionic Contrast and Non-Ionic Contrast with Mannitol

Urograms were performed on sixty patients and patients were randomly allocated to one of three groups. One group of patients received ionic contrast, one group received non-ionic contrast agent alone, and one group received non-ionic contrast agent with Mannitol. All patients had normal renal function. The nephrographic phase of the urograms performed with non-ionic contrast agent, with or without Mannitol, were no better than those performed with ionic contrast agent. However the pyelographic phase of the urograms were better using non-ionic agent than those using ionic contrast media.     

Diagnostic error due to vicarious excretion of rectal iodinated contrast

Introduction of iodinated contrast into the intact colon is not expected to result in imaging‐visible renal excretion of this contrast and is a phenomenon that has only rarely been described. We present a case in which such vicarious renal excretion was misinterpreted as a recto‐vesical fistula which resulted in unnecessary delay in the patient’s management.     

Hexabrix 320R for CT. (Computed Tomography) — Patient Tolerance and Image Quality

A total of 367 patients were studied using Hexabrix 320 as intravenous contrast material during CT scanning. Adverse events were recorded and analysed with respect to patient age and risk category. Hexabrix 320 produced adequate image quality in all patients. Whilst minor adverse events were relatively common, only a few moderate adverse events were seen and no severe adverse events were observed. Hexabrix 320 was noted to be very well tolerated in the elderly and well tolerated by the high risk patient.     

Contrast media and the brain. The basis of computed tomography and magnetic resonance imaging enhancement: A review

The blood, cerebrospinal fluid (CSF), and extracellular fluid of the parenchyma form the fluid compartments of the brain with three interfaces between, namely the blood–brain interface (BBB), the CSF–brain interface, and the blood–CSF interface. When either water‐soluble iodinated contrast media (CM) or water‐soluble paramagnetic CM are injected intravenously, they are rapidly brought into contact with both the BBB and the blood–CSF interface. It is the behaviour of the water‐soluble CM at these two interfaces that determines the normal and abnormal enhancement patterns demonstrated by either CT or MRI. Unlike lipophilic solutes, current iodinated and MRI contrast media all have high affinities for plasma water, low affinities for plasma proteins and, in particular, extremely low partition coefficients. Therefore they do not penetrate the normal BBB. On the other hand, radiopharmaceuticals used in positron emission tomography (PET) and single photon emission computed tomography (SPECT) to demonstrate regional cerebral blood flow are highly lipophilic and readily cross the intact BBB completely during the first pass through the cerebral vasculature. It is the inability of the current iodinated and MRI contrast media to cross the normal intact BBB that is the basis of their use in CT and MRI studies of the brain.     

Intracranial Aneurysmal Rupture and Ventricular Opacification During Carotid Angiography

A case of intra-angiography rupture of an aneurysm, a rarity, is reported. It was confirmed by CT Scan and autopsy. The aneurysm ruptured despite taking all precautions recommended in the literature. This complication may be reduced by the use of non-ionic contrast media and slow flow rate injections.     

Study of patients with intravenous contrast extravasation on CT studies, with radiology staff and ward staff cannulations

Introduction: Intravenous (IV) contrast extravasation is an adverse outcome of computed tomography (CT) studies. This study evaluates for any differences in rates of extravasation between radiology (radiographer) staff and ward medical staff cannulations, and secondarily by cannula size and study type. Method: A prospective study of 26 854 studies in adults between September 2004 and April 2008 accumulated 119 extravasations. Patients were divided into two groups, those cannulated by radiology staff and those cannulated by non‐radiology staff. Patients with extravasations were followed for treatment outcomes. Statistical analysis between our groups was undertaken. Results: The total extravasation rate was 0.44%. The extravasation rate for those patients cannulated by radiology staff was 0.34% (n = 11 470 cannulations) and those cannulated by non‐radiology staff was 0.52% (n = 15 384 cannulations). This was not statistically significantly different. The site where most extravasations occurred was at the elbow (71.4%). The injection rate where most extravasations occurred was in the 1–2 mL/s range (42%). No patient required surgical intervention or had any significant morbidity. Conclusion: Radiology radiographer staff can provide safe administration of IV contrast in CT scanning with low rates of extravasation. Extravasation may occur with high or low injection rates and when small or large size cannulas are used.     

Acute Systemic Reactions to Intravascular Contrast Media –a planned approach

Adverse reactions to intravascular contrast media (ICM) are common and carry a significant mortality rate. Major factors influencing incidence and severity include age, a history of asthma, heart disease, significant allergy, the type of investigation and the type of contrast agent used. Many mechanisms may be involved in producing ICM reactions, including histamine release, complement activation, antigen-antibody reactions and direct cardiovascular effects. In order to deal with these unexpected emergencies, a carefully organised plan is essential. Patients with significant heart disease, asthma, allergy or a history of previous contrast reactions should be referred to major hospitals for their investigation. The use of forearm intravenous cannulae should be encouraged and patients must be carefully observed during ICM administration. Adrenaline is the mainstay of therapy and early intramuscular administration is recommended. Corticosteroids and antihistamines have no role in severe reactions, but bronchodilators and infusion of colloid solutions may be required.     

Water-Soluble Contrast CT Cisternography in CSF Fistulas

High resolution C.T. cisternography with water-soluble contrast media was performed in eight patients with C.S.F. rhinorrhea and suspected C.S.F. fistula. This technique, aided by video fluoroscopy, proved successful in documenting the precise anatomical localisation of the fistulous track in all eight patients. Surgical exploration and correction was done in every case with confirmation of the radiological findings.     

胸部肿瘤三维适形放疗剂量造影剂影响的研究

目的:探讨CT造影剂对胸部肿瘤三维适形放疗剂量的影响.方法:共有40例患者入组,其中食管癌患者34例,肺癌患者6例,中位年龄62岁.在相同扫描条件下分别行CT平扫及增强扫描.在图像融合状态下,分别勾画大体靶区(GTV)、临床靶区(CTV)、计划靶区(PTV)以及危及器官,以平扫图像为基础图像进行剂量计算和计划优化,PTV边缘剂量1.8～2.0 Gy/次,总量45～66 Gy,并以此计划进行治疗.利用计划系统图像融合的功能,将在平扫图像(C-)上勾画的靶区及照射野设计复制到增强图像上,在增强图像(C+)上重新进行剂量计算;分别比较C+和C-图像中相对应的单次治疗照射野MU的不同(按照2 Gy/次计算),肿瘤中心点的剂量、肿瘤边缘点的CT值及剂量的不同;并进行统计学分析.结果:40例患者共有205个照射野,其平扫及增强图像射野MU分别为284.55±63.64和283.00±63.21,P=0.120;肿瘤中心点的剂量分别为平扫(45.219 5±9.561 4) Gy、增强(45.211 7±9.614 5)Gy,P=0.772;肿瘤边缘点的剂量分别为平扫(43.837 2±9.304 9)Gy、增强(42.904 5±9.164 5)Gy,P=0.001;边缘点的CT值分别为平扫(140.83±40.55) HU、增强(39.20±20.82) HU,P=0.00.结论:采用适当的扫描条件,对于胸部肿瘤,可以采用直接增强扫描的方式进行CT定位,使用CT增强扫描对放疗计划的优化影响不明显.     

Transient global amnesia following cerebral angiography with non-ionic contrast medium

Transient global amnesia (TGA) is an uncommon syndrome of recent memory deficit and inability to learn new data, usually resolving within 24 h. Two cases following use of non-ionic contrast media in cerebral angiography are described. The neuroanatomy of memory is reviewed. Possible aetiologies of TGA in relation to cerebral angiography include ischaemia (embolic, arterial spasm), epilepsy that may be primary or tumour-related and direct toxic effects of contrast media.     

Parapharyngeal and retropharyngeal space abscess: an unusual complication of chronic suppurative otitis media

Parapharyngeal and retropharyngeal abscess as a complication of cholesteatoma is an uncommon entity. We present the unusual case of a 32-year-old man with chronic suppurative otitis media, presenting with parapharyngeal and retropharyngeal abscess. This was treated with incision and drainage of the abscess followed by modified radical mastoidectomy for chronic suppurative otitis media.     

Recognition and management of contrast media extravasation

Intravenous contrast agents are frequent adjuncts used in diagnostic imaging. Despite the well‐recognized complications of contrast media extravasation, its treatment remains an enigma to many. This article reviews the recognition, prevention and treatment options, with a summary of the contrast media extravasation policy implemented in our department.     

Chronic bilateral suppurative otitis media caused by Aspergillus terreus

Summary. A case of bilateral suppurative otitis media is described in a patient with the presenting symptoms of otorrhoea, itching, mild deafness, heaviness in the ear and otalgia. The patient had perforation in the tympanic membrane. Histological sections revealed aggregated fungal masses of Aspergillus terreus. The infection responded well to topical ketoconazole therapy. Incidentally, this is the second case from India of chronic suppurative otitis media caused by fungi.
Zusammenfassung. Ein Fall von beidseitiger, eiternder Otitis media mit den Symptomen Otorrhoe, Juckreiz, leichter Taubheit. Druckgefuhl und Schmerzen im Ohr wird beschrieben. Der Patient hatte eine Perforation des Trommelfells. Histologische Schnitte zeigten aggregierte Pilzmassen von Aspergillus terreus. Die Infektion sprach gut auf eine topische Behandlung mit Ketoconazol an. Dies ist in Indien der zweite berichtete Fall von pilzbedingter chronischer, eiternder Otitis media.     

Contrast Media Deaths

Ninety-two deaths resulting from the use of contrast media are described and analyzed together with 228 deaths reported earlier. Of these new deaths, 11 were associated with angiography, 28 with intravenous cholangiography and 53 with urography or C.T. The majority of deaths were associated with cardiac arrest or pulmonary oedema. The mode of death appears to be unrelated to the formulation of the contrast media. The suddenness of the demise and the organs affected suggest that a neurologic mechanism may be involved.