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

• Clinical (if no complication)

Management

• Stop infusion immediately
• Remove IV canula
• Ice pack to affected area
• Elevate
• Consider hyaluronidase for iodinated contrast through the original IV to be given subcutaneously

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

Disposition

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

See Also

• Iatrogenic intra-arterial injection