CT contrast media extravasation

Background

• Complication of contrast-enhanced CT scanning
  • May also occur from MRI, but rare given low volume used
• Ultrasound-guided IVs are at higher risk

Epidemiology

• ~0.5% (range 0.13-0.68%) of cases

Clinical Features

• Swelling and/or blistering at injection site

Differential Diagnosis

Contrast induced complications

• Contrast induced allergic reaction
• Contrast-induced nephropathy
• CT contrast media extravasation
• Nephrogenic systemic fibrosis

Evaluation

Contrast extravasation of 120 ml into the biceps compartment. A and B, External and internal rotation radiographs of the arm approximately one hour after injection show a soft tissue collection of contrast material in the expected location of the biceps compartment that is completely contained with sharp margins.

(a) Extravasation of intravenously injected contrast material. Coronal reformatted CT depicts extravasated contrast in the upper extremity soft tissues. (b) CT scout image after extravasation of intravenously administered contrast in the left upper extremity allows assessment of the extent of extravasation and permits evaluation of possible compartment syndrome.

• Clinical (if no complication)
• Consider plain films and/or CT, if concern for significant complication

Management

• Stop infusion immediately
• Remove IV canula
• Ice pack to affected area
• Elevate
• Consider hyaluronidase for iodinated contrast extravasation
  • Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)
• Monitor for signs of compartment syndrome

Disposition

• May discharge after 2 hours with precautions, if no signs of complications.

Complications

• 97% have minimal or no injury
  • 79% have localized swelling after extravasation
  • 24% had pain
• Large volumes (> 50 mL) of high-osmolar contrast media = highest risk
  • Skin ulceration
  • Soft-tissue necrosis
  • Compartment syndrome

See Also

• Iatrogenic intra-arterial injection