gms | German Medical Science

Objectives/Interrogation: Contrast extravasation is a known but rare complication of imaging test. Various studies consider the rate of extravasation during CT in figures ranging from 0.03%-0.17%

Methods: A 73-year-old man was programmed for another contrast tomography scan to monitor his portal hypertension disease. At the start of the contrast injection, the patient experienced swelling and pain in the hand. No contrast was visible in the thoraco-abdominal images. Local ice and analgesic treatment was recommended. 4 hours after the scan, given increasing pain and swelling of the hand, the patient presented at the emergency department. Physical examination showed tense and swollen hand, with blisters and no loss of sensation. Capillary refill was normal and pain not increased with passive movements. No signs of compartment syndrome were present. We considered conservative approach measures as our first option. Ice, elevation of the forearm, intravenous administration of corticosteroids, analgesic treatment and empiric antibiotic with amoxicillin/clavulanic acid. Evacuation of the multiples blisters at dorsal and volar aspect of the hand and the forearm was carried out. After 24 hours, the symptoms and physical examination improved. Swelling and pain had significantly decreased. There were no new blisters. Two days after, his hand recovered the normal aspect and full active mobilisation of the hand commenced and the patient suffered no long-term sequelae.

Results and Conclusions: There is no general agreement regarding the best approach for the management of extravasation. Elevation of the limb is often useful to reduce edema and cooling the injection site with ice packs is useful in limiting inflammation. The injection of hyaluronidase has also been recommended for patients with large extravasation volumes. Corticosteroids, vasodilators, and other drugs have also been proposed, but most studies have not shown its efficacy. Review of the literature reveals that extravasations of non-ionic contrast of up to 150 ml can be managed conservatively without long-term sequelae. Surgical drainage or liposuction within 6h can be effective, and saline washout as originally describe by Gaul has been shown to be helpful. Urgent surgical drainage and aspiration has been effective when a compartment syndrome has occurred.

Early identification and appropriate management are essential when extravasated volume is large and the clinical signs and symptoms suggest severe injury including compartment syndrome and soft tissue necrosis.