Vicarious excretion of contrast material in a neonate

A 24+5 weeks’ gestation neonate was conservatively managed for necrotising enterocolitis associated with acute kidney injury. His creatinine peaked at 115 µmol/L (day 19), improving to 64 µmol/L (day 31). At 30+0 weeks’ corrected gestation (day 37), weighing 1.02 kg, he remained ventilated and underwent a transcatheter closure of his patent ductus arteriosus (PDA) in a cardiac unit. His PDA’s unusual anatomy (a tortuous anterior course) was closed successfully with a 3/2 AmplatzerADO II AS. He received 4 mL of intravenous iodixanol (Visipaque (320 mgI/mL)), an isotonic iodine-based contrast. After repatriation (day 38), he was poorly perfused with a distended abdomen. Radiographs were taken (figure 1). The images raised concerns with apparently unexplained bowel contrast. Following discussion with cardiology, surgery and radiology, radiology identified vicarious contrast media excretion (VCME). Clinically, he improved rapidly; his creatinine rose to 100 µmol/L, but normalised to 35 µmol/L. Renal follow-up is...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - Category: Perinatology & Neonatology Authors: Tags: Images in neonatal medicine Source Type: research