Spontaneous renal calyceal and ureteric rupture secondary to intravenous contrast during computed tomography intravenous pyelogram

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

Download Full-text

The diagnostic value of intravenous contrast computed tomography in addition to plain computed tomography in dogs with head trauma

BMC Veterinary Research ◽

10.1186/s12917-021-02764-6 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Yasamin Vali ◽

Ingrid Gielen ◽

Sarang Soroori ◽

Eberhard Ludewig

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Head Trauma ◽

Cerebral Edema ◽

Diagnostic Value ◽

Intravenous Contrast ◽

Post Contrast ◽

Traumatic Injuries ◽

Severity Grading ◽

History Of

Abstract Background The aim of this study is to evaluate additional findings which can be detected by post-contrast computed tomography (CCT) in relation to plain CT (PCT) findings in patients presented with head trauma. Medical records of canine patients with the history of head trauma from three institutions were reviewed. PCT- and CCT-anonymized images were evaluated by a veterinary radiologist separately. From the categorized findings the following conclusions were drawn as: abnormalities were identified on (A) PCT but missed on CCT, (B) CCT but missed on PCT, (C) both PCT and CCT. Results Thirty-two patients were included. The results showed that findings identified on CCT or PCT (category A and B) but missed on the other series were limited to mild soft tissue and sinus changes. Overall, 61 different fracture areas, 6 injuries of the temporomandibular joint (TMJ), 4 orbital injuries, 14 nasal cavities with soft tissue density filling, 13 areas of emphysema, 4 symphysis separations, 12 intracranial hemorrhages, 6 cerebral edema, 5 cerebral midline shifts, 3 intracranial aeroceles, 3 brain herniations and 6 intraparenchymal foreign bodies (defined as an abnormal structure located within the brain: e.g. bony fragments, bullet, teeth,..) were identified on both PCT and CCT separately (category C). Severity grading was different in 50% (3/6) of the reported cerebral edema using PCT and CCT images. Conclusion The results showed that PCT is valuable to identify the presence of intracranial traumatic injuries and CCT is not always essential to evaluate vital traumatic changes.

Download Full-text

A rare interesting case of fatal air embolism after intravenous contrast during computed tomography

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.4.2021.237734 ◽

2021 ◽

Vol 17 (4) ◽

pp. 93-96

Author(s):

Naved Y. Hasan ◽

Asiah Salem Rugaan

Keyword(s):

Computed Tomography ◽

Fatal Case ◽

Pulseless Electrical Activity ◽

Air Embolism ◽

Sudden Onset ◽

Radiology Department ◽

Computed Tomography Scan ◽

Intravenous Contrast ◽

Shock State ◽

Tomography Scan

We are reporting a fatal case of air embolism. Although minor cases of air embolism may go unnoticed, this is a case of fatal air embolism after intravenous entry of air, which presented with sudden onset of pulseless electrical activity during a computed tomography scan in the radiology department, requiring cardiopulmonary resuscitation for 15 min. Subsequently, after admission to the intensive care unit, we achieved return of spontaneous circulation. The patient was intubated and ventilated in a shock state. He remained in refractory shock despite of supportive care. Cardiaс arrest was registered again in the catheterization lab and the patient could not be revived after 4 h from the initial cardiac arrest. А computed tomography scan was reported to reveal a significant amount of intra-cardiac air, which was the likely cause patient’s death. The case is a rare condition, which highlights the importance of early diagnosis and delivers a message to the medical staff to have a high index of suspicion in patients who have risk factors, and who develop sudden shock with hypoxemia, in order to treat this potentially life-threatening condition effectively in a timely manner.

Download Full-text

Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen

Canadian Association of Radiologists Journal ◽

10.1177/0846537120905301 ◽

2020 ◽

Vol 71 (3) ◽

pp. 371-387 ◽

Cited By ~ 1

Author(s):

Saira Hamid ◽

Savvas Nicolaou ◽

Faisal Khosa ◽

Gordon Andrews ◽

Nicolas Murray ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Trauma ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Dual Energy ◽

Dual Energy Ct ◽

Vascular Injuries ◽

Intravenous Contrast ◽

Penetrating Abdominal Trauma ◽

Portable Ultrasound

Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.

Download Full-text