Iodinated Contrast Media Extravasation Injuries: Should Osmolality and the Pattern of Distribution Affect Management?: A Literature Review and Case Report Comparison.

Background: Contrast media extravasation injuries are uncommon, and both conservative and surgical management approaches have been previously described. Over time the use of lower osmolar contrast solutions has prompted fewer complications, whereas the use of automated infusion systems has increased the overall incidence. Local radiology departments frequently have their own protocols for the initial management of extravasation injuries, but if the injury is considered more severe or results in soft tissue compromise, the plastic surgery department is often consulted. Surgical management options depend on the nature of the agent and the degree of extravasation. Stab incisions of the overlying skin followed by the application of pressure have been described for injuries which are more severe.

Methods: Two cases were compared in the context of the prevailing literature. One of these was a large volume extravasation of an iodine-based imaging contrast agent with a diffuse distribution pattern, rendering it unsuitable for this method of evacuation. This is contrasted with a case with a more discrete collection better suited to acute evacuation.

Results: This review found that current literature does not account for distribution patterns of extravasation medium in the decision-making process around surgical intervention.

Conclusions: A review of the relevant literature suggests that the pattern of distribution should be accounted for when considering surgical management.