Purpose or Case Report: To report a single institutional experience with intravenous iodinated contrast extravasations (ICE) occurring during CT at a free-standing academic pediatric medical center.
Methods & Materials: IRB approval was not required as this project qualified for a quality improvement designation. This retrospective investigation evaluated ICE occurring over a 34 months period between January 1, 2017 and October 22, 2019. The radiology data, incident reporting system data, and medical records of patients in whom ICE occurred were reviewed to assess incidence, severity, management, and outcomes. ICE were graded according to hospital policy (grade 1 mild to grade 4 severe). Descriptive statistics were used for this observational study.
Results: There were 9,636 contrast enhanced CT studies. ICE occurred in 30/9,636 (0.3 % of all studies). There were 16 infiltrates in 2017, 4 in 2018, and 10 in 2019, with a decrease in infiltrates after initiation of saline test bolus in mid-September 2017. Patient age for ICE episodes ranged from 6 weeks to 26 years (19 females, 11 males; median age 15 years). Contrast injection volumes ranged from 8 mL to 120 mL (mean 72.8 mL), 13 injections with full volume extravasation, 17 with partial volume extravasation. 29/30 ICE episodes were given via power injector, 1 was hand injected (implanted port). Injection rate ranged from 1.2 mL/second to 5 mL/second. Grade 1 or 2 infiltrate occurred in 18 cases, grade 3 or 4 occurred in 12 cases. Hyaluronidase was administered in 22/30 extravasations. Symptoms progressed in 4 of 22 treated patients and 2 developed blisters over the site within 24 hours of ICE. In both patients the blisters resolved with continued monitoring. 2/22 patients were treated with 2 doses of hyaluronidase due to extent of extravasation. Only 1/30 patients required surgical consultation, but no surgical intervention. ICE symptoms resolved within 24 hours for 12 patients, in less than 72 hours for 9 patients, after 72 hours in 2 patients. No sequelae were noted on limited follow-up.
Conclusions: A large single institutional experience with ICE is presented, showing an incidence of 0.3%. Incidence of ICE was decreased after introduction of saline test bolus. Hyaluronidase was used to treat 73.3% of ICE in our series with good outcomes, however, a randomized controlled trial is needed to determine its utility. No cases required surgical intervention.