During power injection of iodinated contrast for CT, a large volume of contrast extravasates into the subcutaneous tissues of the forearm. What is the FIRST-LINE management?

• A Immediate surgical debridement of the affected area
• B Elevate the limb and apply cold compresses, with saline soaks and analgesia as needed ✓
• C Apply a tight compression bandage and massage the area vigorously
• D Infiltrate the site with hyaluronidase in all cases

Explanation

Standard management of contrast extravasation is limb elevation above heart level, intermittent cold compresses to reduce inflammation, and monitoring, since most cases resolve spontaneously. Hyaluronidase infiltration is reserved for selected severe cases, particularly with very high-volume extravasation, not all cases. Vigorous massage risks spreading the irritant, and surgery is considered only for progressive swelling, compartment syndrome or skin ulceration.

Reference: ACR Manual on Contrast Media, current edition ed.

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