Re: Procedure of Sialography

Allergic Reactions-It is impossible to predict which patients will have an adverse reaction to IV administration of contrast material. If an patient has a history of a previous adverse reaction, is hypotensive, in congestive heart failure, pheochromocytoma, multiple myeloma, diabetes mellitus, or has severe renal disease, then contrast material should not be administered. If it is necessary to do so, then it is best to use a non-ionic, iodinated contrast material. It may be beneficial to prophyllactically treat the patient with antihistamines. And, these patients should be closely monitored. In humans, signs may be mild consistenting of nausea, metallic taste sensation, burning sensation in the arm during injection. In these cases, no treatment is generally needed besides monitoring for progression of signs. Signs may progress to flushing of the skin and urticaria. Treatment with antihistamines may be warranted. In moderately severe cases, breathing may become difficult and treatment with steroids may be warranted. In severe cases of anaphylaxis, full CPR may be necessary.

Acute Renal Failure – Occasionally, acute renal failure may result following IV administration of iodinated contrast material. Aggressive treatment with fluids, dopamine, lasix, and mannitol may be warranted.

Aspiration – Aspiration of small volumes of barium sulfate suspension is usually incidental. The barium is eliminated by coughing and the mucocilliary apparatus. The remainder of the barium is removed by macrophages and will accumulate in the tracheobronchial lymph nodes which will then appear opaque for years. Aspiration of large volumes of barium can cause suffocation and suction may be necessary to remove the barium. If gastric contents or other material is aspirated, then pneumonia may result. Often, this is treatable with antibiotics. Aspiration of nonionic, iodinated contrast material may lead to pulmonary edema.

Pulmonary Edema – Life threatening pulmonary edema may develop if iodinated (especially ionic) contrast material is administered into the lungs. Aggressive treatment including oxygen, lasix, and steroids may be necessary.

Seizure – One of the most common adverse reaction to myelography is seizures, especially after cervical injections. These typically occur during recovery from anesthesia or within the next 24 hours. They typically are self-limiting and can be managed with valium or anesthesia. Injection of ionic contrast material during myleography typically results in severe seizures and death.

Peritonitis – Barium will induce granulomas when administered within the peritoneal cavity. This may have mild, inconsequential effects or result in severe abdominal adhesions, abdominal pain, and possible decompensation of the patient. Barium has been injected into the mediastinum of cats with minimal granuloma formation.