Vicarious Excretion
Michael P. Federle, MD, FACR
Key Facts
Terminology
Excretion of parenterally injected contrast medium by organs other than kidneys
Due to hepatobiliary and other routes of excretion
Imaging
Dense bile visible on plain films: Implies impaired, or at least delayed, renal function
VCME ↑ with dose and concentration of CM
VCME is inversely related to GFR
Peaks at 8 to 24 hours
Can be normal finding on CT
Densely opacified bile is still indicative of ↓ renal function
Increased attenuation of ascites fluid
Visible on CT scans
Due to hepatobiliary &/or peritoneal excretion of CM into ascites fluid
Top Differential Diagnoses
Milk of calcium bile
Gallstones and sludge
Iatrogenic: Cholangiography
Hemobilia
Exudative ascites
Diagnostic Checklist
Mild to moderate ↑ density of bile or ascites on CT some hours following parenteral administration of contrast medium may be normal
Greater degrees of opacification of bile or ascites usually indicates renal dysfunction
Dense GB bile evident on plain films of abdomen usually indicates renal dysfunctionRelated posts:
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