Vicarious contrast excretion

Case contributed by Dr Prat-Matifoll

Presentation

76 year old patient who had been run over by a car which caused a severe abdominal trauma.

Patient Data

Age: 76
Gender: Male

Non-contrast enhanced CT - Emergency room

Modality: CT

A non-contrast CT was performed before intravenous contrast injection.

Red arrow: Note the presence of an hypodense gallbladder with some calcified cholelithiasis within.

Non-contrast enhanced CT - 5h

Modality: CT

After 5 hours, the patient presented hemodynamic instability and another CT was performed to rule-out active bleeding.

Non-contrast enhanced CT - 24 hours

Modality: CT

Excretion of intravenous contrast through the hepatobiliary system (vicarious excretion of contrast).

Note the presence of a hyperdense gallbladder with multiple calcified and non-calcified cholelithiasis within.

Case Discussion

Gallbladder opacification from vicarious excretion may indicate decreased renal function (remember the suspicion of a bladder rupture in our patient) although it could be seen after injecting a high dose of contrast (a triphasic CT and angiography were performed) without an underlying renal impairment. In our patient, a contrast-induced nephropathy with increasing values of creatinine was confirmed. 

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Case Information

rID: 45792
Case created: 8th Jun 2016
Last edited: 8th Jun 2016
Inclusion in quiz mode: Excluded

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