Compartment syndrome after contrast extravasation

Case contributed by Dr Joachim Feger

Presentation

Contrast media extravasation at the left forearm during polytrauma CT three days prior. Now increasing pain and swelling of the left forearm in spite of subsequent conservative management.

Patient Data

Age: 20 years
Gender: Male
MRI

MRI of the left forearm

Findings:

Widespread subcutaneous edema of the dorsal forearm.

Volume increase and muscle edema of the muscles within the extensor compartment, especially the abductor and extensor pollicis brevis and longus as well as extensor digitorum and extensor carpi ulnaris muscles.

There is also hyperintensity in T1w images as an indicator for intramuscular hemorrhage and peripheral contrast enhancement the above-mentioned muscles in the extensor compartment of the forearm.

Unremarkable osseous structures. Normal radial and ulnar artery.

Impression:

Compartment syndrome in the extensor compartment of the forearm after contrast media extravasation.

Annotated image

Key findings:

  • bowing of the fascia resulting from an increase of muscular volume (blue arrowheads)
  • muscular edema (yellow star)
  • diffuse T1 hyperintensity due to intramuscular hemorrhage (red star)
  • areas of central hypoenhancement with peripheral contrast enhancement (red arrowheads) indicating hypoperfusion and myonecrosis

Case Discussion

Acute compartment syndrome with myonecrosis is a rare complication of contrast media extravasation 1-3 and lead to an eventful hospital course in this patient after a polytrauma CT.

Imaging findings indicating compartment syndrome 4-6:

  • increased muscular volume with fascial bowing
  • muscle edema and hemorrhage
  • central hypoperfusion and peripheral contrast enhancement indicating myonecrosis

The patient had emergency fasciotomy, which confirmed myonecrosis of the extensor pollicis brevis and extensor digitorum muscles and subsequent debridement and further muscle biopsy specimens were taken. A second look operation thereafter did not show any further areas of necrosis. Eventually, the patient recovered without any functional deficit of the forearm.

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Case information

rID: 76896
Published: 5th May 2020
Last edited: 6th May 2020
Inclusion in quiz mode: Included

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