Successful computed tomography angiogram through tibial intraosseous access: a case report

No prior work had resolved whether bone marrow-based infusion routes could support the high-pressure delivery required for modern vascular imaging. Emergency clinicians often struggle to establish reliable circulatory pathways during life-threatening patient presentations. Standard intravenous lines frequently fail when peripheral vessels collapse due to severe shock or trauma. That uncertainty drove the need for alternative, rapid-access methods in acute care settings. Intraosseous placement serves as a recognized bridge when conventional options remain inaccessible. Previous literature confirms that bone marrow cavities allow for systemic drug absorption during resuscitation efforts. However, the physical integrity of these devices under rapid contrast injection remained largely unverified. This gap motivated the clinical evaluation of bone-based pathways for diagnostic angiography.

The authors aim to determine if the tibial intraosseous route serves as an effective pathway for administering iodinated contrast during computed tomography angiography. This investigation addresses the challenge of obtaining reliable vascular access in patients who are obtunded or in extremis. Standard peripheral veins often collapse during severe cardiovascular instability, preventing the use of conventional imaging protocols. The researchers seek to demonstrate that bone marrow cavities can withstand the high-pressure loads required for diagnostic contrast studies. This study explores whether such an alternative route provides sufficient image quality to rule out life-threatening conditions like pulmonary embolism. The motivation stems from the need for rapid diagnostic tools in acute, life-saving scenarios. By testing this technique, the authors hope to expand the utility of existing emergency access devices. The report highlights the potential for bone-based pathways to bridge the gap in diagnostic capabilities for critically ill patients.

The clinical team employed a retrospective review approach to document a single-patient intervention. They utilized a standard intraosseous needle placed in the proximal tibia to establish circulatory access. The medical staff administered a high-pressure bolus of iodinated contrast through this device. They performed a computed tomography scan to evaluate the pulmonary vasculature for signs of embolism. The approach involved monitoring the site for signs of extravasation during the rapid injection phase. Clinicians assessed the quality of the resulting images based on the opacification of the target vessels. This case study focuses on the feasibility of using bone-based pathways for diagnostic imaging. The team followed established protocols for managing patients in extremis who required urgent diagnostic data.

The primary finding confirms that tibial access successfully supports the high-pressure delivery of iodinated contrast for pulmonary imaging. The resulting computed tomography angiogram provided sufficient clarity to evaluate the patient for massive pulmonary embolism. The pulmonary arteries showed clear opacification, indicating that the contrast reached the target vessels effectively. This outcome demonstrates that the intraosseous device remained stable throughout the high-flow injection process. The patient, who was obtunded and in cardiovascular extremis, received the necessary diagnostic scan despite lacking peripheral venous access. No complications related to the bone-based infusion were reported during the procedure. The quality of the images was sufficient to support clinical decision-making in an emergency setting. These results validate the use of this access route for diagnostic purposes in critically ill individuals.

The authors demonstrate that bone-based infusion pathways support high-pressure contrast delivery for pulmonary imaging. This case provides evidence that tibial access maintains structural integrity during rapid fluid loading. Clinicians may consider this route when standard peripheral options are unavailable for urgent diagnostic procedures. The resulting images provided sufficient clarity to rule out life-threatening vascular obstructions. This report confirms that bone marrow sites function as a viable alternative for contrast-enhanced computed tomography. The findings suggest that device limitations do not preclude high-quality vascular visualization in emergency scenarios. Future practice might incorporate this technique to improve diagnostic capabilities in unstable patients. These observations highlight the utility of bone-based access in complex acute care environments.