Extravasation of radiographic contrast material and compartment syndrome in the hand: a case report.

Abstract

Radiocontrast agents are a type of medical contrast material used to improve the visibility of internal bodily structures in X-ray based imaging techniques such as computed tomography (CT) or radiography. Radiocontrast agents are typically iodine or barium compounds.Extravasation of contrast is a possible complication of imaging studies performed with contrasts. Most extravasations cause minimal swelling or erythema, however, skin necrosis, ulceration and compartment syndrome may occur with extravasation of large volumes of contrast.A case report is presented in which significant extravasation of contrast was caused while injecting the contrast intravenously into the back of the hand of a 50 year old patient during computed tomography. The patient was undergoing chemotherapy. The patient developed a compartment syndrome and a fasciotomy was required. Treatment options are outlined and emphasis is made on prevention of this iatrogenic complication.Some of the preventive measures to avoid these complications include use of non-ionic contrast (low osmolarity), careful choice of the site of intravenous administration, and close monitoring of the patient during injection of contrast to minimize or prevent extravasation injuries. Clear information to patients and prompt recognition of the complication can allow for other non-surgical treatment options than the one required in this case.

Forearm Compartment Syndrome of a Newborn Associated with Extravasation of Contrast Agent

“…In contrary to previous reports [4, 7], clinical manifestations of compartment syndrome were settled within an hour due to the very young age of the patient. In these conditions, generally, treatment method is mainly based on the volume of fluid extravasation.…”

“…In a recent report [7], contrast agent was shown on plain radiographs of the involved hand, and, similarly, we could demonstrate the extension of contrast agent extending to almost the elbow level which was also an evidence of a wide compartment syndrome. It is interesting to note that this compartment syndrome involved both the hand and the forearm, although the catheter was placed just on the dorsum of the hand.…”

“…In our case, although the CT examination took 15 minutes, the compartment syndrome occured in a very short time period. In a recent case report, even an elderly patient did not notify the nurses, despite the disturbing symptoms during CT scan [7, 8]. Thus, close monitoring of the patients—especially neonates—is essential to avoid these kind of extravasation injuries.…”

Extensive Soft Tissue Necrosis Due to Extravasation of Computed Tomography Contrast Medium

“…Infants, young children, elderly people, and uncooperative and unconscious patients are also at higher risk of CM extravasation, as are patients receiving chemotherapy and obese patients, because of the fragility of the vein walls. 1,2,9 Multiple factors are involved in the pathogenesis of injuries related to CM extravasation, including the osmolarity and cytotoxicity of the CM, the extravasated volume, and the mechanical compression effect of the extravasated material. 1,8,10 The clinical presentation of contrast extravasation varies from minor erythema, swelling, and tenderness to skin necrosis with progressive oedema and ulceration.…”

“…Extravasation of iodinated contrast medium (CM) is a well-known complication of intravenous administration for contrast-enhanced computed tomography (CT). [1][2][3] A small volume of extravasated CM may cause localised pain, oedema, and erythema; all of which resolve spontaneously. 4,5 A large volume of extravasation is rare and may result in skin ulceration and extensive soft tissue necrosis.…”