Shoulder arthrography: comparison of morbidity after use of various contrast media.
This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.
D000388:Air; D003287:Contrast Media / Q000009:adverse effects*; D003973:Diatrizoate / Q000009:adverse effects; D003974:Diatrizoate Meglumine / Q000009:adverse effects; D004338:Drug Combinations / Q000009:adverse effects; D004837:Epinephrine / Q000009:adverse effects; D006801:Humans; D008793:Metrizamide / Q000009:adverse effects; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D011897:Random Allocation; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires
D003287:Contrast Media; D004338:Drug Combinations; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; C027278:urovision; D008793:Metrizamide; D004837:Epinephrine