MRI-induced deep tissue burn presenting to the emergency department

As physicians attempt to "Choose Wisely" and decrease ionizing radiation, the use of Magnetic Resonance Imaging (MRI) has increased. While MRI does not expose patients to ionizing radiation, it does expose patients to specific risks, such as thermal burns. Unfortunately, obese patients are at the highest risk for MRI-related thermal burns. A 45-year-old female with history of gastric bypass underwent diagnostic MRI of her left shoulder and required sedation due to severe anxiety. On awakening, she noted pain proximal to her right elbow that was treated conservatively. The patient presented to our emergency department a week later with an occult, MRI-related, full-thickness burn. CT scan revealed subcutaneous tissue stranding extending beyond the overlying blister. The burn required debridement twice at the nearest burn center and healed slowly thereafter. Emergency physicians should be aware of the risks of MRI so they can counsel patients prior to diagnostic MRI and adequately evaluate patients with complaints after MRI. Furthermore, patients with MRI-related burns may rarely present with delayed, occult deep-tissue involvement requiring burn center evaluation and treatment.