Management of CT Contrast Extravasation
Aspiration is not recommended for CT contrast extravasation and should be avoided as a first-line treatment. 1, 2
Assessment of Contrast Extravasation
- Contrast extravasation during CT scans is a relatively common complication that typically results in minimal swelling or erythema with no long-term sequelae 3
- Most extravasations of non-ionic contrast media (which are used in modern practice) are innocuous and can be treated with conservative management 2
- Risk factors for extravasation include female sex, inpatient status, and certain injection parameters such as rate and venous access site 4
Management Algorithm Based on Severity
For extravasation <150 cc without additional symptoms:
- Conservative management is recommended as first-line treatment 1:
- Elevation of the affected extremity
- Active cooling of the area
- Monitoring for changes in symptoms
- Splinting of the affected extremity if appropriate 2
For extravasation ≥150 cc OR presence of concerning symptoms:
- Immediate surgical consultation (plastic surgery or hand surgery) is recommended when 1, 2:
- Extravasation volume is ≥150 cc
- Patient exhibits signs of impaired perfusion
- Patient reports altered sensation
- There is evidence of compartment syndrome (pain, pallor, paresthesia, pulselessness, paralysis) 5
Warning Signs Requiring Urgent Intervention
- Development of compartment syndrome is a serious complication that may require fasciotomy 5
- Signs requiring immediate surgical evaluation include 1, 5:
- Severe pain disproportionate to clinical findings
- Progressive swelling despite conservative measures
- Decreased capillary refill
- Sensory changes in the affected area
- Decreased pulse quality distal to extravasation site
Contraindicated Interventions
- Invasive first-line therapies such as aspiration of contrast material from the extravasation site are not recommended for routine management 1, 2
- Other invasive techniques described in literature but lacking strong evidence include 1:
- Hyaluronidase injection into the extravasation site
- Suction/aspiration with flushing of affected tissue
- "Squeezing technique" to express extravasated contrast
Prevention Strategies
- Use of non-ionic, low-osmolar contrast media (which is standard in modern practice) significantly reduces risk of severe tissue damage 2, 3
- Careful selection of venous access site and close monitoring during injection can minimize extravasation risk 5
- Extravasation detection accessories may help identify extravasation early and reduce the volume extravasated 4
In conclusion, aspiration of extravasated CT contrast is not recommended as a standard approach. Most cases can be managed conservatively, with surgical consultation reserved for large volume extravasations or when concerning symptoms develop.