CT contrast extravasation in the upper extremity: strategies for management.

INTRODUCTION Extravasation of CT scan contrast media into upper extremity subcutaneous tissue is a relatively frequent complication of injection. Potential sequelae of extravasation include compartment syndrome, skin sloughing, and necrosis. Many institutions institute protocols requiring inpatient plastic surgery consultations immediately following extravasation injury to the upper extremity. We hypothesize that conversion to non-ionic contrast media for contrast CT studies has greatly reduced the incidence of severe extravasation injuries, and may alleviate the need for routine hand surgery consultations. METHODS Records from 102 consecutive CT contrast media extravasation injuries were identified. Data acquired from a single institution included type and amount of contrast extravasated, anatomic location, post-procedural clinical symptoms, whether consult was obtained, and final recommendations and outcome. RESULTS In 102 consecutive cases, immediate surgical therapy was necessary in 0. Non-ionic medium was used in 94% of these cases, and ionic dye was used in 6%. Extravasation of less than 100 cc occurred in 90%, and only 10% were greater. Plastic surgery consultation was immediately obtained in 42% of cases. Factors prompting consultation included extravasation >30 cc, and the presence of erythema or induration. Trends for consultation remained without discernable pattern when patients were stratified by age, amount of extravasate, or anatomic location. Conservative management was recommended in all cases. This included elevation of the extremity, frequent pulse and sensation exams, local message, and temporary splinting. There were no secondary complications requiring surgical intervention. CONCLUSIONS Extravasation of non-ionic CT contrast media appears to be innocuous and can be treated with conservative therapy. Plastic surgery consultation should be obtained when there are obvious signs of skin and soft tissue compromise or symptoms of compartment syndrome.

[1]  R. Cohan,et al.  Extravasation of nonionic radiologic contrast media: efficacy of conservative treatment. , 1990, Radiology.

[2]  S. Adusumilli,et al.  Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. , 2007, Radiology.

[3]  P. Chang,et al.  Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection. , 1998, Radiology.

[4]  D. E. Jones,et al.  Extravasations of radiographic contrast material in the upper extremity. , 1988, The Journal of hand surgery.

[5]  J. Mulliken,et al.  Major intravenous extravasation injuries. , 1979, American journal of surgery.

[6]  C. Demirdover,et al.  Treatment options in extravasation injury: an experimental study in rats. , 2002, Plastic and reconstructive surgery.

[7]  J. Göthlin,et al.  Skin necrosis following extravasal injection of contrast medium in phlebography. , 1971, Der Radiologe.

[8]  E. Vandeweyer,et al.  Extravasation Injuries and Emergency Suction as Treatment , 2000, Plastic and reconstructive surgery.

[9]  Mansoor Khan,et al.  Reducing the Morbidity From Extravasation Injuries , 2002, Annals of plastic surgery.

[10]  M. Dalal,et al.  Limb-threatening extravasation injury: topical negative pressure and limb salvage. , 2006, Plastic and reconstructive surgery.

[11]  Y. I. Kim,et al.  Experimental tissue damage after subcutaneous injection of water soluble contrast media. , 1990, Investigative radiology.

[12]  H. Langstein,et al.  Retrospective Study of the Management of Chemotherapeutic Extravasation Injury , 2002, Annals of plastic surgery.

[13]  C. Sistrom,et al.  Extravasation of iopamidol and iohexol during contrast-enhanced CT: report of 28 cases. , 1991, Radiology.

[14]  L. Hedlund,et al.  Extravascular extravasation of radiographic contrast media. Effects of conventional and low-osmolar agents in the rat thigh. , 1990, Investigative radiology.