Severe iodinated contrast extravasation following coronary CT angiography: A case report

Severe iodinated contrast extravasation is a recognized complication of coronary computed tomography angiography (CCTA) that can progress to significant soft tissue injury if not promptly managed. We report the case of a 66-year-old female patient with a history of lung cancer surgery who developed severe contrast extravasation following the high-pressure injection of iohexol via a dorsal hand vein. The injury rapidly progressed to tension blisters and extensive subcutaneous effusion. Comprehensive staged management was implemented, beginning with acute cold compresses, escalating to timely minimally invasive puncture and drainage of 40 mL of liquefied necrotic tissue on day 8, and concluding with supportive topical wound care. After 27 days of integrated management, the swelling completely resolved with full restoration of skin integrity and no functional impairment. This case highlights that severe contrast extravasation may progress from inflammatory edema to tissue liquefaction, underscoring the necessity of early recognition and timely decompression to prevent necrosis and preserve hand function.