Vicarious contrast material excretion (VCME) defines excretion of water-soluble contrast material in a way other than via normal renal excretion. The most common vicarious excretion of water-soluble contrast material is via the liver, resulting in increased bile density seen in the gallbladder. It can also occur via the small bowel or into ascitic fluid 3.
Although commonly associated with obstructive uropathy, parenchymal renal pathology or impaired renal function, vicarious excretion of contrast may be a normal variant in some individuals without an underlying renal impairment and does not in itself indicate renal or hepatobiliary pathology 1. Also, it could normally occur after injecting a high dose of contrast (e.g triphasic CT or angiography).
It is not uncommon to see high-density pericardial fluid on a non-contrast CT chest performed in patients who underwent recent cardiac catheterization, and it should not be mistaken with hemopericardium 5.
Vicarious excretion of iodinated contrast through the kidneys could occur after oral positive contrast studies 6.
- 1. Hopper KD, Weingast G, Rudikoff J et-al. Vicarious excretion of water-soluble contrast media into the gallbladder in patients with normal serum creatinine. Invest Radiol. 1988;23 (8): 604-8. - Pubmed citation
- 2. Dyer RB, Gilpin JW, Zagoria RJ et-al. Vicarious contrast material excretion in patients with acute unilateral ureteral obstruction. Radiology. 1990;177 (3): 739-42. Radiology (abstract) - Pubmed citation
- 3. Krauthamer A, Maldjian PD. Visualization of Noncalcified Gallstones on CT Due to Vicarious Excretion of Intravenous Contrast. J Radiol Case Rep. 2008;2 (2): 5-8. doi:10.3941/jrcr.v2i2.29 - Free text at pubmed - Pubmed citation
- 4. Lautin E. JAMA: The Journal of the American Medical Association. 1982;247 (11): . doi:10.1001/jama.1982.03320360058038
- 5. Avery LL, Jain VR, Cohen HW et-al. High attenuation pericardial fluid on CT following cardiac catheterization. Emerg Radiol. 2014;21 (4): 381-6. doi:10.1007/s10140-014-1211-7 - Free text at pubmed - Pubmed citation
- 6. Yarmohammadi H, Vogelius E, Meyers M, Azar N. Vicarious urinary excretion of iodinated contrast in a Crohn's patient. (2010) Journal of radiology case reports. 4 (2): 5-8. doi:10.3941/jrcr.v4i2.296 - Pubmed
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Physics and imaging technology: CT
computed tomography (CT)
- CT technology
- dual energy CT
- CT image reconstruction
- CT image quality
- CT dose
CT contrast medium
- iodinated contrast media
- coronary CT angiography
- patient-based artifacts
- physics-based artifacts
- hardware-based artifacts
- CT safety
- history of CT