An injection from the past: fluoroscopic evidence of remote injections of radiopaque substances.

Abstract:

OBJECTIVE:Although uncommon, residual effects from contrast agents used more than 2 decades ago are possible. This case report is to alert clinicians to the implications of residual oil-based ionic contrast agents in the intrathecal space. CASE REPORT:A 70-year-old female with evidence of degenerative disc disease underwent a series of lumbar epidural steroid injections. Fluoroscopy during the procedure revealed diffuse residual intrathecal iophendylate (Pantopaque) dye. We were able to demonstrate unrestricted epidural spread of 1 mL iohexol (Omnipaque 180) alongside the preexisting dye. CONCLUSIONS:The goal of this case report is to highlight the potential of residual myelographic dye to complicate interventional procedures. Such residual dye can increase the level of difficulty in performing interventional pain treatments and perhaps the rate of complications associated with epidural injections, such as dural puncture. The presence of large amounts of residual oil-based intrathecal dye can lead to erroneous interpretations of the dye patterns as intraspinal lipoma or hemorrhage. As a consequence, the patient can be submitted to unnecessary diagnostic and therapeutic interventions. In addition, concerns of worsening oil-based dye-induced arachnoiditis with the use of epidural steroid injections can complicate the treatment of patients with back pain.

journal_name

Reg Anesth Pain Med

authors

Navani A,Dominguez CL,Hald JK,Fishman SM

doi

10.1016/j.rapm.2005.07.193

subject

Has Abstract

pub_date

2006-01-01 00:00:00

pages

82-5

issue

1

eissn

1098-7339

issn

1532-8651

pii

S1098-7339(05)00561-4

journal_volume

31

pub_type

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