Presentation & Early Recognition of Contrast Reactions

Contrast-enhanced CT frequently detects anatomic variants, is useful to evaluate adjacent masses, and can definitively detect large thrombi though flow-related artifacts may simulate thrombi, particularly adjacent to the renal veins. Pulmonary Arteries In most institutions, pulmonary arterial imaging is most commonly performed to diagnose potential acute pulmonary embolism (PE). Pulmonary angiography is the accepted diagnostic standard and, using PIOPED data, usually is indicated for patients with an intermediate or indeterminate probability ventilation/perfusion lung scan, with discordance between the clinical index of suspicion for PE and the lung scan interpretation, or with a high-probability lung scan but a contraindication to systemic anticoagulation. Because the treatment for pulmonary embolism is usually identical to that for lower extremity DVT and because the majority of patients with angiographically proved PE have lower extremity DVT, many clinicians prefer to screen patients who are candidates for pulmonary angiography with bilateral lower extremity venous sonograms and proceed to pulmonary arteriography only if the sonograms are negative. Less commonly, pulmonary angiography is performed with suspected chronic PE-either for evaluation of pulmonary arterial hypertension or before pulmonary thromboendartectomy. Magnetic resonance angiography shows promise for diagnosis of large central pulmonary emboli in patients with contraindications to pulmonary arteriography. Similarly, bolus-enhanced spiral CT angiography appears to be reasonably accurate for diagnosis of chronic PE as well as central acute PE. Acquired diseases that may cause focal arterial narrowing include Takayasu's arteritis, tuberculosis, neoplasia, radiation, and prior surgery. Congenital disorders that may require pulmonary angiography include pulmonary atresia (with bronchial or other systemic arterial collaterals), pulmonary valvular stenosis with poststenotic dilatation, multiple pulmonary arterial stenoses, and pulmonary arteriovenous fistulae.

Upper Extremity Veins Godwin JD, Chen JTT. Thoracic venous anatomy. AJR 1986; 147:674-684. Nazarian GK, Foshager Me. Color Doppler sonography of the thoracic inlet veins. RadioGraphics 1995; 15:1357-1371. Knudson GI, Wiedmeyer DA, Erickson SJ, et al. Color Doppler sonographic imaging in the assessment of upper extremity deep venous thrombosis. AJR 1990; 154:399-403. Haire WD, Lynch G, Lieberman RP, Lund GB, Edney JA. Utility of duplex ultrasound in the diagnosis of asymptomatic catheter-induced subclavian vein thrombosis. J Ultrasound Med 1991; 10:493-496. Rose SC, Gomes AS, Yoon He. Magnetic resonance angiography for mapping potential central venous access sites in patients with advanced venous occlusive disease. AJR 1996; 166:1181-1187. Venae Cavae Kellman GM, Alpern MB, Sandler MA, Craig BM. Computed tomography of vena cava anomalies with embryologic correlation. RadioGraphics 1988; 8:533536. Hicks ME, Malden ES, Vesely TM, Picus D, Darcy MD. Prospective anatomic study of the inferior vena cava and renal veins: comparison of selected renal venography with cavography and relevance in filter placement. ]VIR 1995; 6:721-729. Pulmonary Arteries PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. JAMA 1990; 263:2753-2759. Gefter WE, Hatabu H, Holland GA, Gupta KB, Henschke CI, Palevsky HI. Pulmonary thromboembolism: recent developments in diagnosis with CT and MR imaging. Radiology 1995; 197:561-574.

Categorical Course - Clinical Management and Life Support in Interventional Radiology

Selected Bibliography

PART I (C102)

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Lower Extremity Veins Sumner DS. Diagnosis of deep venous thrombosis In: Rutherford RB, Ed. Vascular surgery. 4th ed. Philadelphia: W.B. Saunders, 1995; 1744-1770. Rose se. Venography. In: Rutherford RB, Ed. Vascular surgery. 4th ed. Philadelphia: W.B. Saunders, 1995; 1744-1770. Krigaton RA, Priest DL, Zwerboz W], Lawrence PF, Miner FJ, Rose Se. Lower extremity deep venous color duplex imaging; examination technique. Radiographics 1990; 10:775-786. Laissy JP, Cinqualibre A, Loshkajian A, et al. Assessments of deep venous thrombosis in the lower limbs and pelvis: MR venography versus duplex Doppler sonography. AJR 1996; 167:971-975.

Moderator: Michael A. Bettman, MD 1:30 pm Contrast Media & Premedication

Bernard F. King, MD 2:00 pm Presentation & Early Recognition of Contrast Reactions Karl N. Krecke, MD 2:25 pm Treatment of Contrast Reactions

Speaker to be announced