Pantopaque contrast mimicking intracanalicular vestibular schwannoma

Deep, Nicholas L.; Patel, Ajay Kumar; Hoxworth, Joseph M.; Barrs, David M.

doi:10.1002/lary.26340

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Mild or severe headache, meningitis, vertigo, imbalance, arachnoidids, hydrocephalus, hypersensitivity have been reported in patients who have intracranial remnants of myodil (4,(9)(10)(11). Although some authors believed that the remnants of pantopaque in the intracranial subarachnoid space should be removed (10), symptomatic treatment and/or periodic follow-up are usually accepted approaches by several authors in minor symptomatic and/or asymptomatic cases (4,8,9,14). Accordingly, in the present cases, no further examinations were carried out in the asymptomatic patient (Case 1), but the patient who complained from headache and backache (Case 2) was advised to visit a neurologist.…”

Section: Discussionmentioning

confidence: 99%

Unusual radiographic images of radiopaque contrast media incidentally observed in intracranial region: two case reports

et al. 2019

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Unusual radiographic images of radiopaque contrast media incidentally observed in intracranial region: two case reportsThe oil-based contrast medium has extremely slow clearance rate from cerebrospinal fluid. The medium known as myodil or pantopaque or iopenydylate was firstly introduced in 1944 to be used in myelography, cisternography and ventriculography. It was commonly used until 1980s but was later replaced by watersoluble mediums in 1990s because of its complication and sequelae. Although rare, images of the remnants may still be encountered on radiograms since its remnants may be seen after six decades. In this article, incidental radiopaque images in panoramic radiography and cone-beam computed tomography (CBCT) were presented in two patients whose myelography was taken before herniated discs' operation. Unusual incidental radiopacities in intracranial region were observed on panoramic radiography image of a male and CBCT image of a female, both of whom underwent myelography more than 30 years ago. Dentomaxillofacial radiologists should be aware of this radiographic appearance, should be able to differentiate it from possible pathologies.

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Section: Discussionmentioning

confidence: 99%

Unusual radiographic images of radiopaque contrast media incidentally observed in intracranial region: two case reports

et al. 2019

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“…Many of these cases noted pantopaque exposure many decades before presentation, with abnormal imaging noted on CT, MRI, and dental panoramic radiographs. Previous cases have noted the MRI appearance of pantopaque as hyperintense on T1-weighted images and iso- to hypointense on T2-weighted images without gadolinium enhancement [ 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Since its discontinuation, imaging studies with findings suspicious of intradural oil-based contrast have rarely been reported. Although few, there have been documented cases of pantopaque noted on imaging in the spine and intracranially [3][4][5][6]. Many of these cases noted pantopaque exposure many decades before presentation, with abnormal imaging noted on CT, MRI, and dental panoramic radiographs.…”

Section: Introductionmentioning

confidence: 99%

Pantopaque: Does It Still Migrate With Gravity After 30 Years?

Ma¹,

Jacobs²,

Bui³

et al. 2022

Cureus

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Pantopaque was an oil-based positive contrast media used in central nervous system imaging before the use of water-soluble contrast agents. It is no longer used due to side effects, including arachnoiditis. Prior studies have indicated that remnants of pantopaque can be seen in modern radiographic imaging, including CT and MRI. With its use obsolete, these remnants have been increasingly mislabeled from “tumor” to “shot gun pellets”. An understanding of this historic modality will usually lead to the correct diagnosis.

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The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

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Pantopaque contrast mimicking intracanalicular vestibular schwannoma

Cited by 3 publications

References 9 publications

Unusual radiographic images of radiopaque contrast media incidentally observed in intracranial region: two case reports

Unusual radiographic images of radiopaque contrast media incidentally observed in intracranial region: two case reports

Pantopaque: Does It Still Migrate With Gravity After 30 Years?

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

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