Contrast agent extravasation in external jugular vein - 31/05/23

Doi : 10.1016/j.ajem.2023.04.046

Van Trung Hoang ^a,^{^⁎} , The Huan Hoang ^a, Cong Thao Trinh ^b, Ngoc Thanh Hoang ^c
^a Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Viet Nam
^b Department of Radiology, FV Hospital, Ho Chi Minh City, Viet Nam
^c Department of Radiology, University of Medicine and Pharmacy, Hue, Viet Nam

^⁎Corresponding author at: Department of Radiology, Thien Hanh Hospital, 17 Nguyen Chi Thanh Street, Buon Ma Thuot 630000, Viet Nam.Department of RadiologyThien Hanh Hospital17 Nguyen Chi Thanh StreetBuon Ma Thuot630000Viet Nam

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A 71-year-old woman presented to the emergency department with acute chest and abdominal pain. Clinical diagnosis was severe pneumonia, respiratory failure, chronic adrenal insufficiency, acute kidney injury, dyslipidemia, hypoalbuminemia, ischemic heart disease, osteoarthritis, and suspected pulmonary embolism. A CT scan of the chest and abdomen was performed for the overall evaluation. In the Intensive Care Unit (ICU), because peripheral IV catheters could not be inserted for contrast administration, a conventional 18G IV cannula was placed in the left external jugular vein. In the radiology department, the line was checked for good backflow and tested with saline bolus without complications. Pre-contrast CT scan (Fig. 1A) of the thorax and abdomen was conducted. Then a contrast CT scan was performed with a manual injection of 100 mL of contrast medium. Immediately after injecting about 50 ml of contrast agent, the patient complained of pain and the technologist detected there was extravasation with slight swelling in the left neck, the catheter was immediately withdrawn and compression was carried out at the injection site. The patient was transferred back to the ICU for monitoring, in the first two hours there were no hemodynamic abnormalities. The patient was consented and a central venous line was inserted in the right jugular vein. A contrast-enhanced CT with contrast injection in the central line went smoothly without complications. CT image (Fig. 1B) showed contrast extravasation into the soft-tissue spaces of the neck and chest, including the mediastinum. Contrast extravasation into the left neck was monitored for 3 days, while the patient was receiving treatment for her acute conditions. No progression of swelling or additional complications were observed during these 3 days. The patient was subsequently discharged from the hospital approximately 2 weeks after her admission.