Delayed cardiac tamponade following accidental injection of non-ionic contrast medium into the pericardium

A case of cardiac tamponade developing over 10 hours after accidental injection of 80 ml iohexol (350 mg i/ml) during an intravenous digital subtraction arteriography (DSA) examination is described.     

Delayed eruption caused by non-ionic contrast material injection

An investigation was conducted into the adverse reactions, especially delayed reactions, of non-ionic contrast media. Out of a total number of 3,411 people treated, there were 45 cases (1.32%) in which adverse reactions were observed, and of these 45 cases, 14 cases (0.41% of the total number) showed delayed adverse reactions. Of the aforesaid 14 patients with delayed adverse reactions, all of them developed skin eruptions, but no seriously adverse effects were eventually observed.     

Renal effects of the non-ionic contrast medium iopentol after intravenous injection in healthy volunteers

Renal effects of the new non-ionic contrast medium iopentol in increasing doses were assessed and compared with the effects of physiologic saline. Twenty-four healthy male volunteers, allocated to three dose groups, were given iopentol intravenously in doses of 0.3, 0.6, and 1.2 g I/kg body weight, respectively. The highest dose group was also given physiologic saline separately as a control. The diuresis increased in all groups, most in the highest dose group, and with a concomitant fall of urine osmolality and increase in osmolar clearance. A slight decrease of serum osmolality, creatinine and urea occurred at 3 hours due to hemodilution. The glomerular filtration rate was unaffected by iopentol. The urinary excretion of albumin and beta 2-microglobulin was unchanged. However, urinary N-acetyl-beta-glucosaminidase and alkaline phosphatase increased significantly, most in the highest dose group. All changes were reversible.     

Myelography with the non-ionic water-soluble contrast medium metrizamide.

Technical problems in myelography with the water-soluble contrast medium, metrizamide are analysed and a technique used for examination of the entire spinal subarachnoid space is described. The choice of gas or water-soluble contrast medium for myelography is also discussed.     

Severe liver injury with hematological disorders following the injection of non-ionic contrast medium. A case report

We describe a dramatic case of severe liver injury and hematological disorders following the injection of non-ionic contrast medium in a 49-year-old woman with endometrial cancer. This case developed into a fulminant hepatitis-like picture that required repeated plasmapheresis and hemodialysis.     

Idiosyncratic reaction to intracoronary injection of non-ionic contrast media

Four patients who developed coronary artery spasm in response to their first intracoronary injection of a non-ionic contrast agent, either iopamidol or iohexol, are described. It is suggested that this idiosyncratic reaction may be related to the non-ionic character of these contrast media.     

Immediate and non-immediate reaction after non-ionic X-ray contrast medium injection: Case report and review of the literature

Maculopapular rush (exanthema) is the most common contrast medium (CM)-induced non-immediate (delayed) reaction, accounting for over 50% of affected patients. In this article, we describe the clinical course of a 50-year-old female patient who underwent CM-enhanced computer tomography (CT). During non-ionic CM-injection (iopromide) she developed dyspnoea and itching. 24 h afterwards the patient presented with generalized small red macules that tended to confluence (maculopapular exanthema) and itching. Because in vivo testing was not possible, we analyzed blood cells by the cellular allergen stimulation test (CAST), and found slightly increased leukotriene production in the presence of iopromide, while another CM (iotrolan) did not induce leukotriene production. In addition we reviewed available literature for CM related maculopapular exanthema. This clinical feature due to CM is a characteristic delayed (non-immediate) reaction that usually occurs 24 h after CM administration and has been preferentially reported due to non-ionic dimeric CM. Laboratory tests like the CAST that are used in parallel with in vivo skin tests would be of great relevance but are currently not validated. As to whether intra-individual reactions with both immediate and delayed symptoms after CM-injection occur seldom or have been only rarely reported is currently unknown.     

Cerebral angiography with the non-ionic water-soluble contrast medium Iohexol and Meglumine-Ca-Metrizoate

Summary A double blind study was carried out to evaluate safety, tolerability and visualization quality of the non-ionic contrast medium Iohexol compared to Meglumine-Ca-Metrizoate (Isopaque Cerebral) for cerebral angiography. The two contrast media were found equal in most respects. A slight increase in systolic blood pressure following Meglumine-Ca-Metrizoate injections and a slight decrease in diastolic blood pressure following Iohexol were statistically significant. Tachycardia following injections of Meglumine-Ca-Metrizoate in the aortic arch was also significant and may indicate more discomfort from this medium, although no difference was found in patient interviews. The changes in blood pressure and heart rate were small and of no clinical importance.     

Complications of brachiocephalic catheter angiography using a non-ionic contrast medium

In 713 patients 749 catheter-arteriographies of aortic-arch and cerebral vessels were performed using non-ionic contrast media. The patients were examined either with DSA or conventional film techniques. In 80 examinations of 76 patients complications or side-effects were noted, which resolved completely within one hour in 69 cases, showed a duration up to 7 days in 6 cases, and persisted longer than 7 days in 5 patients. Neurological complications were seen in 6.4% of the studies. There was no death. Patients, who received anti-hypertensive drugs before or during angiography and patients with a pathological angiogram had a significantly higher complication-rate. The rising number of patients with atherosclerotic cerebrovascular disease showed an unfavorable effect upon the overall complication-rate. The use of a non-ionic contrast medium did not drastically lower the rate of neurological complications.     

Iopamidol,a new non-ionic hydrosoluble contrast medium for neuroradiology

Summary The side effects associated with the use of Iopamidol for myelography were determined in 100 patients and compared with metrizamide in a double-blind study.     

Pulmonary edema induced by contrast medium. A comparative investigation in the rat following high intravenous doses of one ionic (diatrizoate) and non-ionic (metrizamide) contrast medium

Monomeric ionic contrast media are known to induce a significant degree of pulmonary edema following intravenous injection of high doses of contrast media in rats. This edema has been shown to be dependent on dose and rate of injection. Metrizamide administered at the same dose causes much less and more transient pulmonary edema than diatrizoate. Although blood osmolalities were significantly and consistently lower following administration of metrizamide compared with diatrizoate, this difference alone does not account for the difference in the degree of pulmonary edema induced by these media.     

Improvement of IVDSA of the brachiocephalic arteries using a non-ionic contrast medium

Summary The introduction of IVDSA provides a safer method of angiographic investigation of the aortic arch and brachiocephalic arteries than conventional angiography in patients with cerebro-vascular disease. The quality of visualization however decreases. Instead of changing over to IADSA we find it worthwile to try to improve IVDSA in different ways. One of them is represented in this prospective double blind cross-over study in which we have investigated the effects of using an isotonic non-ionic contrast medium, iohexol (omnipaque), in comparison to meglumin-sodium-diatrizoate (urografin) which is widely used. Iohexol causes less severe side-effects, less severe artifacts and a better image quality. A statistical relation between parameters could not be established. A lag-effect exists for side-effects. The necessity of using low osmolar contrast media is discussed.     

Radiculography with non-ionic contrast medium: routine bed rest is unnecessary

In a prospective study into the occurrence of side-effects, 200 patients who had undergone iopamidol radiculography were randomly allocated into two groups, one being confined to bed for 24 h and the other allowed to be fully ambulant. We found that the incidence of side-effects was not increased by allowing the patients to remain ambulant and that headache and dizziness were significantly less frequent than in a comparable study in which we had used metrizamide.     

Cisternography with the non-ionic water-soluble contrast medium metrizamide. A preliminary report.

In 11 patients the basal cisterns in the posterior cranial fossa were examined with the new water-soluble compound metrizamide. Promising results were obtained when the medium was administered suboccipitally or through the foramen ovale but less favourable after lumbar administration. The clinical tolerance of the compound with regard to short term effects was good.