Hepatobiliary and pancreatic: Biliary tract opacification after angiography
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
22
Journal Issue
11
Pages
2034
Date Issued
2007
Author(s)
Abstract
In patients with normal renal function, radiologic contrast materials used in angiography are largely excreted by the kidneys. However, hepatobiliary excretion is an alternative pathway that normally accounts for less than 2% of the contrast dose. Because of this, the amount of contrast within the biliary system is usually insufficient for detection of contrast on a plain abdominal radiography or a computed tomography (CT) scan. However, in some patients, biliary excretion can increase because of impaired renal function, high doses of contrast or enhanced protein binding of contrast material. In these settings, contrast can be detected within the biliary system at variable times (ranging from 30 min to 72 h) after the injection of contrast. In some articles, this is called vicarious excretion of contrast material. The term, vicarious, implies excretion at an abnormal site since angiography almost always results in opacification of the urinary tract. The patient illustrated below was a 77-year-old man with hypertension and mild renal impairment (plasma creatinine, 130 μmol/L). He had previously had angioplasty and stenting for cerebrovascular disease and was admitted for repeat angiography and possible angioplasty. During the procedure he was given 100 mL (1.53 mg/kg) of ioxaglate (Hexabrix, Guerbet, Aulnay-sous-Bois, France). The procedure was followed by hypotension, generalized pruritis and facial swelling. These features were presumed to be an adverse reaction to the contrast material and the patient was transferred to the Intensive Care Unit. A non-contrast abdominal CT scan was performed 3 h after the procedure to exclude the possibility of internal bleeding. There was contrast in the gallbladder and bile duct as shown in 1, 2. Contrast was also noted in both ureters. He improved rapidly and was discharged from hospital after 2 days. Biliary opacification appears to be more common with ioxaglate than other contrast materials, perhaps because of greater binding to serum proteins. This feature should not be confused with other biliary disorders such as a porcelain gallbladder.
SDGs
Other Subjects
ioxaglic acid; meglumine ioxaglate plus sodium ioxaglate; contrast medium; diagnostic agent; ioxaglic acid; aged; angiocardiography; article; biliary tract disease; case report; cerebrovascular disease; computer assisted tomography; coronary stent; face edema; hepatobiliary system; human; hypertension; hypotension; intensive care; kidney dysfunction; male; pancreas; priority journal; pruritus; angiography; computer assisted tomography; hepatobiliary system; metabolism; methodology; radiography; Aged; Angiography; Biliary Tract; Contrast Media; Humans; Ioxaglic Acid; Male; Tomography, X-Ray Computed
Publisher
Blackwell Publishing
Type
journal article