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CT contrast extravasation in children: a single-center experience and systematic review

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Abstract

Background

Extravasation of iodinated contrast material during computed tomography (CT) is a rare complication. A few patients may develop severe complications such as compartment syndrome.

Objective

The purpose of this study was to retrospectively assess the prevalence, severity, management, and outcome of contrast extravasations in our institution and to perform a comparison to what has been reported in the existing literature.

Materials and methods

This is a research ethics board (REB)–approved retrospective study comprising 11 patients who had intravenous contrast-enhanced CT between 2019 and 2022 in a tertiary pediatric center, and experienced extravasation of iodinated contrast as a complication. Age, weight, sex, co-morbidities, angiocatheter size, venous access location, total contrast volume, flow rate, patient’s symptoms, severity of injury, and management were collected. For the systematic review, PRISMA guidelines were followed.

Results

Only 11 (0.3%) (0.17-0.54 (95%CI)) contrast extravasations occurred in a total of 3638 CTs performed with intravenous contrast during the same period in children. The median age (IQR) was 12.5 (10.0, 15.0) years. In our cohort, 1/11 patients developed compartment syndrome and required fasciotomy. The systematic review assessed 12 articles representing a population of 110 children with extravasations. Pooled prevalence from articles stratified by age was 0.32% (0.06-0.58% (95%CI)). Only three children experienced moderate to severe complications.

Conclusions

We confirm that severe complications of contrast extravasation are rare and can occur at any age. No strong associations were seen with the need for surgical consultation (including age, sex, weight, flow rate, injection site, catheter size, and type of contrast).

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Katie O’Hearn, Msc (Children’s Hospital of Eastern Ontario Research Institute), for methodological assistance and Tamara Rader, MLIS (Independent Information Specialist), for developing the electronic search strategies. We also thank Cassandra Kapoor (Research Assistant) and the CT technologists in our department for their help in collecting the data.

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Authors and Affiliations

  1. Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada

    Maria F. Dien Esquivel, Elka Miller & Rita Putnins

  2. Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Maria F. Dien Esquivel & Elka Miller

  3. CHEO Research Institute, CHEO, University of Ottawa, Ottawa, ON, Canada

    Vid Bijelić & Nick Barrowman

Authors
  1. Maria F. Dien Esquivel
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  2. Elka Miller
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  5. Rita Putnins
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Contributions

M.F.D.E. analyzed and interpreted the data and drafted the initial manuscript.

E.M. conceived and supervised the study.

V.B. performed the statistical analysis.

N.B. performed the statistical analysis.

R.P. collected the data and conceived and supervised the study.

All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Maria F. Dien Esquivel.

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Dien Esquivel, M.F., Miller, E., Bijelić, V. et al. CT contrast extravasation in children: a single-center experience and systematic review. Pediatr Radiol 54, 34–42 (2024). https://doi.org/10.1007/s00247-023-05811-6

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  • DOI: https://doi.org/10.1007/s00247-023-05811-6

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