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.

• 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