[Radiologic position control of epidural catheters (epidurography). An instrument of quality assurance for regional analgesia]. / Radiologische Lagekontrolle von Epiduralkathetern (Epidurographie). Ein instrument der Qualitätssicherung für die Regionalanalgesie.

Epidural analgesia is a very efficient method of postoperative pain management. Nevertheless, problems such as unilateral analgesia, sensory loss and inadequate pain relief are often difficult to handle. Radiologic evaluation of the position of the catheter and the spread of radiopaque dye (epidurography) is an important advance toward a solution of these problems. METHODS. The findings of 110 consecutive epidurographies from the acute pain service of the Department of Anaesthesiology of the University Hospital of Kiel, Germany, were analysed. Radiograms were obtained following the injection of 2 ml and an additional 8 ml of radiopaque dye (iopamidol) in the anterior-posterior and lateral plane. In addition, typical and instructive examples of epidurographies from the past 8 years are presented. RESULTS. In 99 of 110 patients the epidurography revealed a proper position of the catheter. Seven cases of partial displacement (e.g. paravertebral spread of radiopaque dye) and two cases of complete misplacement were documented. Allergic reactions or other side effects were not observed. The radiologic criteria for a proper epidural position of the catheter are discussed (Fig. 2a). Furthermore, examples of the following malpositions of epidural catheters are presented: intravascular misplacement (Fig. 2b), paravertebral misplacement (Fig. 2c), paravertebral escape of radiopaque dye (Fig. 2e) and correct distribution after the catheter had been withdrawn 2 cm (Fig. 2f), intrathecal misplacement (Fig. 2g), and simultaneous spread of dye in the subarachnoid and epidural space in a patient with preceding dural tap (Fig. 2h). In some cases unexpected reasons for problems in postoperative pain management were revealed by epidurography (e.g. disc prolapse, (Fig. 2d). CONCLUSION. In our view epidurography is a valuable way of improving the quality and safety of postoperative epidural analgesia. It is an important tool for decision-making in the event of clinical problems. The benefits for the patients have to be weighed against the radiation exposure.

[Symptomless lung sequestration]. / Die symptomlose Lungensequestration.

Two cases of asymptomatic intralobar pulmonary sequestrations are reported. Chest radiographs showed a solid intrapulmonary mass left posterior at the base. By computed tomography the exact localization and relationship of the sequesters to the surrounding tissue were demonstrated, and a bolus injection of contrast medium revealed the supplying arteries. The arteriography showed a single arterial supply in both cases and their exact course. In the late phase the pulmonary veins were visualized. Finally a suggested diagnostic workup is given.

[Indirect azygos-vein-continuation syndrome with aneurysm of the inferior vena cava]. / Indirektes Vena azygos-Kontinuations-Syndrom mit Aneurysma der Vena cava inferior.

Nausea and emesis after exercise were leading symptoms in a 28 year old patient with indirect vena azygos continuation syndrome. This anomaly was verified by sonography, abdominal CT and by venography. The CT examination revealed initially structures of malignant appearance low to the renal position by angiography. This appeared to be distended collaterals. Therapeutic intervention aims primarily to the prevention of complications such as thrombosis of the distal venous flow or venous insufficiency of the lower extremities. Prophylactically we suggest low dose heparin and compression stockings.