J Korean Radiol Soc.  1989 Feb;25(1):1-10. 10.3348/jkrs.1989.25.1.1.

An experimental study on tissue reaction of various contrast agents on mediastinum

• Chung JW
• Kim HJ
• Kim SH
• Park JH
• Chang KH

• KMID: 2383144
• DOI: http://doi.org/10.3348/jkrs.1989.25.1.1

Abstract

Till now, there is no consensus about appropriate contrast agents for use in clinical investigation insuspected perforation of the esophagus. Gastrografin, most widely used water-soluble contrast agent, is lesssensitive in detection of fistulous tract and can induce pulmonary edema, leading to death occasionally, ifaspirated. Barium sulphate has been contraindicated without actual evaluation of its effect on mediastinum byexperimental and clinical study. The purpose of this experimental study is to evaluate the type of tissue reactionand its severity in mediastinum and, as a result, to propose appropriate contreast agents in various clinicalsituations of suspected esophageal leakage. Barium sulphate, Hytrast, Gastrografin, Telebrix, Hexabrix, Amipaque,Niopam, and Ultravist were injected into mediastinum of 20 rats in each. The tissue reaction of injection siteswere examined microscopically and graded according to severity of inflammatory reaction with serial follow-up from1 day to 8 weeks after injection. The results are as follows, 1. Barium sulphate and Hytrast produced highlysignificant (p<0.01) tissue reaction compared to saline group and early inflammatory reaction was more severe inHytrast. 2. Water soluble agents produced no significant reaction in mediastinum compared to saline control groupand proved to be safe in the situation of leakage into mediastinum. 3. Injected garium caused no death during 8week follow-up inspite of large injected amount and histologically produced localized indolent granuloma after 4weeks which is expected not to cause any delayed complications. In consideration of above results, superiorphysical characteristics of barium sulphate and drawbacks of Gastrografin, we concluded as follows. 1. Forpostoperative assessment of esophageal anastomosis, Barium sulphate is the contrast agent of choice. 2. Insupstected gross lesakage into mediastinum or esohagopleural fistula, water-soluble agents are recommended. Inhigh risk patients of pulmonary aspiration, Hexabrix is safer than gastrografin. 3. If leakage is not demonstratedwith water-soluble agents, Barium study must be repeated to find missed fistulous tract.

MeSH Terms

Animals
Barium
Clinical Study
Consensus
Contrast Media*
Diatrizoate Meglumine
Esophagus
Fistula
Follow-Up Studies
Granuloma
Humans
Ioxaglic Acid
Mediastinum*
Pulmonary Edema
Rats
Water
Barium
Contrast Media
Diatrizoate Meglumine
Ioxaglic Acid
Water