Air Bubbles Mimic Disc Herniation in MRI after Cervical Epidural Block

Kim, Tae Sam; Shin, Sung Sik; Kim, Jung Ryul; Kim, Dal Yong

doi:10.3344/kjp.2010.23.3.202

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…There were 36 cases related to pain management complications or adverse events. Although they included contents related to pain procedures, including drug allergy and diagnosis issues [ 23 24 25 ], they only examined extremely rare cases for academic purposes. Therefore, these cases are not applicable to practical law issues affecting pain physicians.…”

Section: Discussionmentioning

confidence: 99%

Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

Kim

Moon²

2015

Korean J Pain

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BackgroundPain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea.MethodsData on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained.ResultsPain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest.ConclusionsMore systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur.

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Section: Discussionmentioning

confidence: 99%

Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

Kim

Moon²

2015

Korean J Pain

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“…They reported that air bubbles collect near the outlet space for the exiting nerve roots. Therefore, while a large amount of air injection may cause radiculopathy, even the smallest amount of air may show up on an MRI as a herniated disc [13]. …”

Section: Discussionmentioning

confidence: 99%

Motor Weakness after Caudal Epidural Injection Using the Air-acceptance Test

et al. 2013

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Air injected into the epidural space may spread along the nerves of the paravertebral space. Depending on the location of the air, neurologic complications such as multiradicular syndrome, lumbar root compression, and even paraplegia may occur. However, cases of motor weakness caused by air bubbles after caudal epidural injection are rare. A 44-year-old female patient received a caudal epidural injection after an air-acceptance test. Four hours later, she complained of motor weakness in the right lower extremity and numbness of the S1 dermatome. Magnetic resonance imaging showed no anomalies other than an air bubble measuring 13 mm in length and 0.337 ml in volume positioned near the right S1 root. Her symptoms completely regressed within 48 hours.

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“…In patients receiving an ESI for treatment of spinal diseases, there is a possibility of misreading or difficulty in interpretation of MR images because of air or fluid in the epidural space after the injection. Kim et al [ 7 ] reported a case of air bubbles mimicking disc herniation in MR images acquired after a cervical epidural block. Additionally, Ammirati and Perino [ 8 ] reported a case of symptomatic epidural air trapped in the spine after ESI.…”

Section: Introductionmentioning

confidence: 99%

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

et al. 2017

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BackgroundMagnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain.MethodsWe reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air.ResultsThe incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later.ConclusionsPain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.

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Air Bubbles Mimic Disc Herniation in MRI after Cervical Epidural Block

Cited by 11 publications

References 10 publications

Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

Motor Weakness after Caudal Epidural Injection Using the Air-acceptance Test

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

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