RadteraFistulogram / Sinogram
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Define course/extent of a cutaneous fistula or sinus tract
- Identify communication with bowel, bladder, abscess cavity, or other viscus
- Postoperative wound/anastomotic leak evaluation
- Enterocutaneous, colocutaneous, or perianal fistula mapping
- Assess drainage catheter tract
Patient prep
- Identify external opening; clean and prep skin around the orifice
- No bowel prep typically; review prior cross-sectional imaging
- Have appropriate catheters/cannulas and occlusive technique ready
Contrast
AgentWater-soluble iodinated contrast (avoid barium where bowel/peritoneal communication possible)
Routevia the external tract opening (catheter/cannula, sometimes with a purse-string or occlusive seal at skin)
DoseInject under fluoroscopy until tract and any cavity/communication opacify
TimingReal-time fluoroscopy during slow injection
Technique
- Place a small catheter into the external opening; create a seal to prevent reflux at the skin
- Inject water-soluble contrast slowly under fluoroscopy to opacify the tract
- Obtain multiple obliquities to define course, branching, and any communication with bowel/bladder/cavity
- Document length, depth, and termination of the tract
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Scout | AP over region | Surgical clips, drains, gas |
| 2 | Tract opacification | AP + obliques | Course, branching, length |
| 3 | Communication views | Multiple obliques | Connection to bowel/bladder/abscess |
Key points
- Use water-soluble contrast (not barium) — barium in a tract communicating with peritoneum or soft tissues causes granulomatous reaction
- Multiple projections essential to map true tract course and communications
- Cross-sectional CT/MR may complement for deep/complex tracts and abscesses
- Maintain a tight seal at the skin opening to achieve adequate filling pressure
- Stop if patient reports significant pain or if contrast tracks into venous structures
References
• Radiopaedia: Sinogram / fistulogram
• ACR–SPR Practice Parameter for the Performance of Contrast Examinations (GI tract / fistula evaluation)
• Standard institutional fluoroscopy protocols
• ACR–SPR Practice Parameter for the Performance of Contrast Examinations (GI tract / fistula evaluation)
• Standard institutional fluoroscopy protocols
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.