Question

Dye used in the diagnosis of esophageal perforation:

• A. Iohexol
• B. Barium sulphate
• C. Gadolinium
• D. Iodine dye

Hint:

Leaked barium causes mediastinitis, so the first agent must be water-soluble.

Answer 1

The Correct Option is A

Step 1: When an esophageal perforation is suspected, the contrast study must rule out a leak without harming the mediastinum if extravasation occurs. Step 2: Barium sulphate gives excellent mucosal detail, but if it leaks through a perforation into the mediastinum it incites a severe, irreversible chemical mediastinitis and granulomatous reaction. For this reason a water-soluble iodinated contrast is used first. Step 3: Iohexol (Omnipaque) is a low-osmolar, non-ionic, water-soluble iodinated agent. If it leaks it is harmlessly absorbed, making it the safe initial agent to detect extraluminal contrast extravasation in a suspected perforation. Step 4: Gadolinium is an MRI agent and is not used for esophagography; "iodine dye" as written is non-specific and not a standard named oral contrast. Barium is only added later in small amounts if the water-soluble study shows no leak. So the dye used to diagnose esophageal perforation is the water-soluble iodinated agent, Iohexol.