CT contrast media extravasation: Difference between revisions
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==Background== | ==Background== | ||
* | *Complication of contrast-enhanced CT scanning | ||
** | **May also occur from MRI, but rare given low volume used | ||
*[[Ultrasound-assisted peripheral line placement|Ultrasound-guided IVs]] are at higher risk<ref>Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001</ref> | *[[Ultrasound-assisted peripheral line placement|Ultrasound-guided IVs]] are at higher risk<ref>Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001</ref> | ||
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==Evaluation== | ==Evaluation== | ||
[[File:PMC4891405 gr1.png|thumb|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.]] | |||
[[File:PMC5265191 13244 2016 524 Fig4 HTML.png|thumb|(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) | *Clinical (if no complication) | ||
*Consider plain films and/or CT, if concern for significant complication | |||
==Management== | ==Management== | ||
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*Ice pack to affected area | *Ice pack to affected area | ||
*Elevate | *Elevate | ||
*Consider hyaluronidase<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> | *Consider hyaluronidase for iodinated contrast extravasation<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> | ||
**Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)<ref>https://pubmed.ncbi.nlm.nih.gov/22633726/</ref> | |||
*Monitor for signs of [[compartment syndrome]] | |||
==Disposition== | |||
*May discharge after 2 hours with precautions, if no signs of complications. | |||
==Complications== | ==Complications== | ||
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**79% have localized swelling after extravasation | **79% have localized swelling after extravasation | ||
**24% had pain | **24% had pain | ||
*Large volumes (> 50 mL) of high-osmolar contrast media = highest risk | *Large volumes (> 50 mL) of high-osmolar contrast media = highest risk | ||
** | **Skin ulceration | ||
** | **Soft-tissue necrosis | ||
**[[ | **[[Compartment syndrome]] | ||
==See Also== | ==See Also== | ||
Latest revision as of 11:58, 25 November 2021
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[1]
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[2]
- Give subcutaneously around the extravasation site using a 27-gauge needle (e.g. in a circle around original IV)[3]
- 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
External Links
References
- ↑ Dargin JM, Rebholz CM, Lowenstein RA, Mitchell PM, Feldman JA. Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access. Am J Emerg Med. 2010;28(1):1-7. doi:10.1016/j.ajem.2008.09.001
- ↑ https://pubmed.ncbi.nlm.nih.gov/22633726/
- ↑ https://pubmed.ncbi.nlm.nih.gov/22633726/