Q: 65 year old male is recovering in ICU after community-acquired pneumonia. During a physical therapy session, patient injured his shoulder. Orthopedic service requested to order Arthrography. Would you order an intravenous (IV) contrast? (select one)
A) Yes
B) No
Answer: B
The objective of the above question is to highlight the common practice in ICU of ordering contrasts with radiological studies, leading to contrast-induced nephropathy (CIN). For most of the bone Magnetic Resonance Imagings (MRIs), IV contrast is not needed unless bone tumor or abscess is suspected. Arthrography of the shoulder requires percutaneous contrast. Ideally, it should be performed under fluoroscopy or ultrasound for proper needle placement. Extravasation of contrast is consistent with a full-thickness rotator cuff tear.
#orthopedic
#trauma
#nephrology
References:
1. Opsha O, Malik A, Baltazar R, et al. MRI of the rotator cuff and internal derangement. Eur J Radiol 2008; 68:36.
2. Lungu E, Moser TP. A practical guide for performing arthrography under fluoroscopic or ultrasound guidance. Insights Imaging. 2015;6(6):601-610. doi:10.1007/s13244-015-0442-9
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