What is the most common severe injury that may occur following extravasation of intravenous contrast material?
Acute compartment syndrome is the most common severe injury following intravenous contrast extravasation. This is an extremely rare complication, which occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure secondary to the increased fluid content, leading to muscle and nerve ischemia. It is more likely to occur after the extravasation of a large volume of contrast material, particularly when located in less capacious/distensible areas of the extremity such as the hand, wrist, or forearm.
If there is clinical evidence for a severe extravasation injury such as progressive swelling or pain, altered tissue perfusion as manifested by a decreased capillary refill, change in sensation in the affected limb, or skin ulceration or blistering, then immediate surgical consultation is indicated. Compartment syndrome is typically treated with decompressive fasciotomy.