Arch Hand Microsurg.  2023 Mar;28(1):43-46. 10.12790/ahm.22.0051.

Immediate surgical treatment for massive extravasation of computed tomography contrast medium in the hand: a case report

• Yoo BW
• Oh KS
• Kim J
• Kim KN
• Shin HW

• KMID: 2540030
• DOI: http://doi.org/10.12790/ahm.22.0051

Abstract

There are no treatment guidelines for the extravasation of contrast medium. A 71-year-old man underwent coronary artery computed tomography. When contrast medium (iohexol) was injected through the right cephalic vein, massive leakage into the surrounding tissues occurred. A physical examination showed severe swelling of the hand and a prolonged capillary refill time. X-rays showed a massive accumulation of contrast medium in the hand. We immediately performed surgical treatment, including four skin incisions on the hand, subcutaneous dissection, and squeezing, which led to the removal of 50 mL of liquid. The immediate postoperative radiographic findings showed dramatic fading of most of the contrast medium. Four days postoperatively, radiography showed complete dissolution of all contrast medium, and a physical examination revealed full recovery of skin color and capillary refill time. We successfully managed massive extravasation of contrast medium in the hand with immediate surgical treatment. An immediate surgical approach for massive extravasation should be considered to achieve favorable outcomes.

Keyword

Extravasation of diagnostic and therapeutic materials; Computed tomography; X-rays

Figure

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  Fig. 1. Preoperative images at 1 hour after extravasation. (A, B) Preoperative X-ray shows severe swelling and marked contrast enhancement. (C, D) Preoperative image of purple discoloration on the dorsal side of the hand, indicating decreased circulation.

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  Fig. 2. Immediate postoperative X-ray images. (A, B) X-ray findings show dramatic fading of the contrast agent with decreased swelling.

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  Fig. 3. Follow-up X-ray images and clinical photographs. (A, B) X-ray findings at a 5-day follow-up show no contrast agent left. (C, D) The skin color had returned to nearly normal without any necrosis at a 10-day follow-up.

Reference

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