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Diagnostic Imaging > Lecture 4: Contrast complications > Flashcards

Lecture 4: Contrast complications Flashcards

1
Q

why use contrast medium

A
  1. Opacify specific structures to increase contrast resolution
  2. With radiography only way to differentiate structures is when they are different opacities
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2
Q

what are the 4 types of contrast

A
  1. Gas
  2. Barium
  3. Iodinated
  4. Paramagnetic agents
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3
Q

what are the routes of administering contrast

A

IV, intrathecal, intraperitoneal, oral, intra-articular

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4
Q

Is hypague 76 contrast ionic or non-ionic

A

ionic

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5
Q

are iohexol 350 and 240 ionic or non-ionic contrasts

A

non-ionic

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6
Q

what are some indications for iodinated contrast

A

urinary study, angiography, CT, lymph angiography, arthrography, myelography

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7
Q

Only use ionic or non-ionic iodinated contrast in myelographs

A

non-ionic

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8
Q

Iodinated contrast is __times the osmolality of plasma

A

5-8 times

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9
Q

what is the advantage of ionic contrast

A

less expensive

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10
Q

what are the disadvantages of ionic contrast

A

hypertonicity- increased risk of reaction

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11
Q

You can not administer ionic contrast __

A

intrathecally

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12
Q

what are some advantages of non-ionic contrast

A

lower reaction rate, less hypertonic, useful for any procedure

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13
Q

what is the disadvantage for iodinated contrast

A

expensive

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14
Q

what are some toxicities associated with iodinated contrast

A
  1. Osmolality- primary effect
  2. Ionic charge
  3. Chemical toxicity
  4. Allergic or idiosyncratic reaction
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15
Q

what osmolality changes does contrast cause

A

shift of water from extravascular to intravascular space, shift of water out of RBC

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16
Q

what endothelial and RBC lesions are seen as the result of negative osmolality effects

A
  1. Desiccation and weakening of junctions
  2. Increase capillary permeability
  3. RBC dedicate and are rigid
  4. Risk of thrombosis formation
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17
Q

what are the cardiovascular effects of osmolality changes from iodinated contrast

A
  1. Vasodilation- severe hypotension
  2. Osmotic hypervolemia
  3. Reflex tachycardia
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18
Q

what are the renal affects of osmolality changes from iodinated contrast

A

diuresis, acute renal failure- hypertonicity and chemical toxicity

19
Q

what are some non-specific reactions to osmolality changes from iodinated contrast

A

nausea, vomiting, chills, fever, headache

20
Q

what CNS is very sensitive to ionic composition changes and can result in __ or ___

A

seizures or cardiac dysfunction

21
Q

ionic or non-ionic: results in ionic composition changes that can cause seizures or cardiac dysfunction

A

ionic (does not occur with non-ionic)

22
Q

T or f: sodium is toxic but compounds with megluimine are less toxic

A

true

23
Q

t or f: non-ionic compounds have no sodium, therefore less toxic

A

true

24
Q

Iodinated compounds directly induce ___degranulation and ___release

A

mast cell, histamine

25
Q

T or F: iodinated contrasts suppress erythrocyte function

A

true

26
Q

which intrathecal iodine injection site has increased adverse reactions: cisternal or lumbar

A

cisternal>lumbr

27
Q

how do you determine volume of contrast given intrathecal

A

volume of contrast/mL of CSF

28
Q

what factors have no effect on incidence of reactions in intrathecal iodine administration

A

dose, time of anesthesia, anesthetic protocol

29
Q

__therapy may decrease risk of seizures when administering intrathecal iodine

A

fluid

30
Q

what neurotoxicities are associated with contrast administration

A
  1. increased capillary permeability in BBB allows toxic substances to contact neurons
  2. Ionization disrupts neurotransmission
31
Q

what are some intrathecal iodine reactions

A
  1. Seizures
  2. Hyperthermia
  3. Transient apnea
  4. Transient muscle spasms
  5. Hypotension
  6. Opisthotonus
32
Q

what is gadolinium based contrast

A

injectable paramagnetic substance

33
Q

paramagnetic substances shorten __ and __relxation times

A

T1 and T2

34
Q

T or F: gadolinium is highly toxic

A

true

35
Q

since gadolinium is highly toxic is must be ___

A

chelated, DTPA most common

36
Q

what are the mechanism of reactions associated with gadolinium based contrast

A

stability, osmolality

37
Q

what are some indicates for gas contrast

A

cystography, pneumoventriculography, ultrasound, peritoneography, pericardiography

38
Q

what are some reactions associated with gas contrast

A

air emboli- rare complication

39
Q

what are some signs of air emboli from gas contrast

A

occlude flow, infarct of affected area

40
Q

what is tx for air emboli from gas contrast

A

Place left lateral recumbency and catheterize right atrium to try and extract emboli (often fatal complication)

41
Q

What reactions are associated with barium contrast

A

only concern if extravasation into body cavity- severe granulomatous inflammation

42
Q

what are some signs of a barium reaction

A

abdominal pain, mild to severe peritoneal adhesions

43
Q

what is tx for barium reaction

A

immediate lavaging may minimize reaction

Diagnostic Imaging (4 decks)

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