Sinogram.

What is sinogram?

It is a special X-ray procedure that is done with contrast dye to visualize any abnormal opening (sinus) in the body. The contrast is injected via a rubber catheter. Serial x-ray pictures are taken to show the extension of the fistula.

Other name for sinogram is fistulogram.

What kind of contrast medium used in this procedure?

A low osmolar contrast medium, LOCM 150.

How is it done?

Technique :

1. A prelim film is taken to exclude the presence of radio-opaque foreign body.
2. A fine catheter is then inserted into the orifice of the sinus.
3. After a gauze pad has been firmly placed over the orifice to discourage reflux, the contrast medium is injected under fluoroscopic control.
4. Spot films are taken as required including tangential views.

Below are sequence of films taken to investigate a sinus at right mid thigh.

1. Prelim :  shows intramedullary fixation of right femur fracture. Site of fistula is located at mid thigh.

2. Right thigh AP : Dye is injected. There is a focal collection of contrast seen.

3. Lateral view : shows focal collection of contrast.

4. Right lower thigh AP : shows  seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh.

5. Right upper thigh AP : shows seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh up to the level of hip joint and distally to the level of distal femur (just above the femoral condyles).

How is it reported?

NAME : ?

I/C : ?

SINOGRAM (01.04.2010)

Procedures:

Patient wound is cleaned. Sinus identified.

25 ml undiluted omipaque injected using 8F nasogastric tube.

Serial x-rays are taken.

Findings:

There is flow of contrast from the sinus into a focal collection measuring 3.5×4.5cm.

Seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh.

Superiorly the contrast extends to the level of hip joint and distally to the level of distal femur (just above the femoral condyles).

There is no connection to the knee or hip joint.

CONCLUSION

No evidence of intra-articular extension of the right thigh abscess.

Radiologist 01.04.2010

Qs.

1.Why do I need a sinogram?

It is needed when your doctor has decided that you need this test to show passage of a cavity in the body that opens out onto the skin surface.

2.Where will the procedure take place ?

In a special room ( Fluoroscopy  room ) within the x-ray department.

3.How do I prepare for sonogram?

No special prep is required.

4.Who will be doing the sinogram?

Medical officer observed by radiologist /Radiologist.

5.What is actually happen during sinogram ?

a)      You may be asked to wear gown.

b)      Medical officer/ Radiologist will once again explain the procedure to you.

c)      Your skin will be washed with antiseptic solution and a small catheter is inserted into the opening of the sinus on the skin surface.

d)     A small amount of contrast is injected through the catheter into the sinus and serial x-rays are taken to show where the sinus goes.

e)      When all the x-rays have been taken, the catheter will be removed and your skin will be covered with a sterile dressing.

*If you normally use a stoma bag please bring a spare with you.This order only applies to abdomen related fistula or sinus.

6.Will it hurt?

You may experience a little discomfort during the procedure but there is usually no pain. If there is pain during the procedure, please tell someone.

7.How long will it take?

Around 30 minutes.

8.Are they any risks or complications ?

There may be a small amount of bleeding from the sinus for a short time.

Reference :

1. A Guide to Radiological Procedures Stephen Chapman.