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July 1960

Costal Intraosseous Venography in Portal Hypertension *

Author Affiliations

New York
From the Departments of Surgery and Radiology, Veterans Administration Hospital, Bronx, and the Department of Surgery, St. Vincent's Hospital.

Arch Surg. 1960;81(1):143-150. doi:10.1001/archsurg.1960.01300010145027

It is the purpose of this exhibit to present the value of costal intraosseous venography in the diagnosis of portal hypertension.

Rationale  The injection of contrast medium directly into the medullary cavity of a lower rib demonstrates venous pathways not outlined by conventional means. Under normal conditions, the intrathoracic vascular pattern appears fairly constant. In portal hypertension, costal intraosseous venography demonstrates systemic venous collaterals in contradistinction to splenoportography, which visualizes portal venous collaterals.

Technique  The patient is thoroughly informed about the procedure and is told to expect some mild discomfort at the site of bony puncture. Precautionary tests against possible idiosyncrasies to the contrast medium or local anesthetic agent must be carried out. Adequate sedation of the patient is achieved with meperidine hydrochloride (Demerol) 100 mg., and secobarbital (Seconal) sodium 100 mg., both drugs being administered one hour prior to the procedure.With the patient supine on the x-ray table,

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