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

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).

Successful adjunctive treatment of compartment syndrome due to acute isocyanate inhalation using hyperbaric oxygen therapy: case report.

Introduction: Isocyanates are the raw materials that make up all polyurethane products. Isocyanate is a powerful irritant to the mucosal membrane of the respiratory tract, eyes and skin. Pulmonary symptoms, especially occupational asthma, are predominant manifestations of isocyanate toxicity. Case report: We report mental changes and compartment syndrome complicated with rhabdomyolysis as an extraordinary manifestation of acute isocyanate toxicity observed in a patient during the waterproofing of a water tank. A 58-year-old man recovered consciousness after six hours in the emergency department and complained of severe pain in the lower leg. The results of his laboratory test showed that his serum creatine kinase (15,250 IU/L) level had increased. The tissue pressure in both the lower legs had increased to 180 mmHg/170 mmHg (right/left). We performed fasciotomy on the second day of hospitalization. The patient was provided hyperbaric oxygen (HBO2) therapy of 2.0 ATA for 90 minutes twice a day for seven days. His condition gradually improved over five months, and he did not require amputation. He had a mild neurological disorder in his foot and was transferred to a rehabilitation center five months after hospitalization. Conclusion: It is important to note that when working with isocyanate, non-specific complications such as a change in consciousness as well as compartment syndrome with rhabdomyolysis can occur in a confined space or high-temperature environment. In addition, we found that compartment syndrome caused by isocyanate toxicity can be effectively treated with fasciotomy and HBO2 therapy.

[A case of acute osteofascial compartment syndrome caused by rodenticide poisoning].

Acute osteofascial compartment syndrome is a series of symptoms and signs caused by acute ischemia of muscles and nerves in osteofascial compartment. If it is not treated in time, it can lead to tissue necrosis. It is rare that it is caused by rodenticide poisoning. Such patients are often difficult to diagnose and treat early and have poor prognosis. In May 2018, a patient with acute osteofascial compartment syndrome caused by anticoagulant rodenticide poisoning was admitted to the Twelfth Hospital of Guangzhou City. After systematic treatment, he finally recovered and discharged. The early manifestations of this patient were mainly coagulation dysfunction, and finally acute osteofascial compartment syndrome. 5 days later, the diagnosis was made, and the operation of incision decompression and vacuum sealing drainage (VSD) was performed.

[Compartment syndrome of the forearm after intra-arterial self-injection : With a mixture of methadone, flunitrazepam, saliva and water]. / Kompartmentsyndrom des Unterarms nach intraarterieller Autoinjektion : Mit einem Gemisch aus Methadon, Flunitrazepam, Speichel und Wasser.

A drug-addicted patient injected himself intra-arterially with a mixture of methadone, flunitrazepam, saliva and water. The resulting compartment syndrome could be treated by fasciotomy and multiple debridement, with which a major amputation could be prevented. The course of the treatment and the resulting functional results are described, as well as a brief overview of the literature and a treatment proposal for similar cases.

Limb-Threatening Ischemia in a Young Man with Cathinone "Bath Salt" Intoxication: A Case Report.

"Bath salts" are synthetic designer drugs that have stimulant properties and are a growing medical concern. The chemical compounds in the mixtures have an affinity for receptors in the brain resulting in a stimulant effect similar to that seen with methamphetamines and cocaine. Although illegal in Canada, these drugs are widely available online with over 20 synthetic drugs marketed as "bath salts" and used increasingly among recreational drug users. Much of the medical literature regarding these drugs comes from emergency medicine case reports, which outline the acute, severe medical, and psychiatric effects of "bath salt" toxicity. In this report, we outline severe vascular limb compromise, which occurred in a 24-year-old man who took large doses of bath salts obtained online from China. We detail our experience to re-establish perfusion to the limbs, and the morbidities encountered due to the ischemic insult our patient experienced. The duration and clinical presentation of "bath salt" toxicity are frequently complicated by lack of toxicology screens for the agents on board, and lack of any pharmacokinetic evidence surrounding these synthetic compounds. Although "bath salts" are now illegal in Canada, these drugs are widely available online and have become an increasing public health concern that involves significant morbidity and mortality to users. Creating a base of knowledge and front-line experience are the only current tool in combating the diverse detrimental aftermath of these synthetic agents' abuse.

Compartment syndrome following thrombolysis: clinical features and associated conditions.

Major complications of thrombolysis are intracranial and extracranial bleedings. Compartment syndrome (CS) as a serious adverse event is sparsely reported. The purpose of the study is to present a systematic review of the literature on this complication based on a case vignette. A PubMed and Google Scholar search on CS following thrombolysis was performed. Twenty-four patients (11 male, 11 female, 2 not noted; median age 66 years, range 19-85 years) with thrombolysis associated CS were identified. Fifteen patients had thrombolysis with rtPA, 4 patients with streptokinase, 3 patients with urokinase, and 2 patients with tenecteplase. In 15 cases, CS affected the upper limb, and in 9 cases the lower limb. Indication for thrombolysis was myocardial infarction in 11 patients, arterial occlusion of the leg in 6 patients, pulmonary embolism in 4 patients, stroke in 2 patients, and deep venous thrombosis in 1 patient. In addition, in 15 cases, aspirin/ticlopidin, and/or heparin in therapeutic dosages had been prescribed. In 15 cases manipulations of the affected limb had been preceding. In both stroke patients, a hidden fracture was later diagnosed. The median time to the diagnosis of CS was 12 h (2 h-3 days). Therapy was mostly surgical with fasciotomy. The outcome of CS was favorable in 14 cases. However, in 5 cases, nerve damage persisted, and amputation was indicated in 2 patients. CS following thrombolysis is a rare condition. As predisposing factors different manipulations, hidden fracture and pronounced antithrombotic therapy are encountered.

Spontaneous and non-spontaneous bleeding complications in patients with oral vitamin K antagonist therapy.

PURPOSE: The aim of the study was to evaluate potential differences between patients with spontaneous and non-spontaneous bleeding episodes during treatment with vitamin K antagonists which mainly resulted in compartment syndromes. METHODS: The population in this study comprised 116 patients who suffered at least one bleeding complication which required surgical treatment during therapy with an oral vitamin K antagonist. The patients were treated between September 2001 and July 2008. RESULTS: Significant differences were observed between the two patient groups with regard to the presence of renal failure, arterial hypertension, and diabetes mellitus, which occurred more frequently in patients with spontaneous bleeding. Also, significantly more patients with spontaneous bleedings developed compartment syndrome that needed emergency operation. Overall mortality was 9.6 %, was associated with multiorgan failure in all patients, and was not different between the two patient groups. CONCLUSIONS: The identification of high-risk patients before treatment with an oral vitamin K antagonist is of major importance. The existence of over-anticoagulation syndrome and compartment syndrome is associated with significant mortality and morbidity and should not be underestimated.

[Development of compartment syndrome after intravenous administration of an X-ray contrast medium. Recommendations on acute therapy regimens]. / Kompartmentsyndrom nach paravasaler Applikation von Röntgenkontrastmittel. Empfehlung zum akuten Therapieregime.

The incidence of extravasation of contrast medium is reported in the literature to be between 0.2 % and 0.9 %. A rare consequence of this could be compartment syndrome of the affected limb which requires immediate treatment.We report the case of a patient who developed acute compartment syndrome of the forearm after intravenous injection of radiographic contrast medium in a radiovolar vein during a computed tomography (CT) scan for multiple trauma. The clinical symptoms with pain, loss of range of motion and sensitivity functions, measurement of compartment pressure and radiological images confirmed the diagnosis. After emergency dermatofasciotomy of the forearm the full range of motion and sensitivity functions could be restored.

Compartment syndrome after "bath salts" use: a case series.

In recent years, synthetic cathinones, often labeled as "bath salts" in an attempt to evade drug laws, have emerged as substances of abuse. Sympathomimetic drugs are well known to cause rhabdomyolysis but are rarely associated with acute compartment syndrome. In this case series, we describe 3 patients who presented with sympathomimetic signs or symptoms including hyperthermia and agitation and had confirmed synthetic cathinone use. All 3 patients had severe rhabdomyolysis with delayed development of an acute compartment syndrome. Two patients developed paraspinal compartment syndromes, whereas 1 developed bilateral forearm compartment syndromes. Management included fasciotomy in 2 patients and medical management in the third. Two of the 3 patients made a complete recovery before hospital discharge; the third patient was hemodialysis dependent at 5-month follow-up.

Spontaneous compartment syndrome of the upper arm in a patient receiving anticoagulation therapy.

BACKGROUND: Compartment syndrome is a condition in which elevated pressures within an osseofascial compartment cause vascular compromise, leading to ischemia and possible necrosis. It commonly occurs after a traumatic event (e.g., fracture, crush, burn); however, compartment syndrome can happen spontaneously and in any compartment of the body. The objective of this case study is to present the signs and symptoms of upper arm compartment syndrome along with a review of the diagnosis and treatment. CASE REPORT: A 75-year-old man receiving anticoagulation for atrial fibrillation developed compartment syndrome in the extensor compartment of his upper arm, diagnosed by clinical examination with the aid of a venous duplex ultrasound study. CONCLUSION: Although uncommon, spontaneous compartment syndrome can occur, and prompt recognition and intervention are limb- and possibly life-saving.

Bilateral simultaneous traumatic upper arm compartment syndromes associated with anabolic steroids.

BACKGROUND: Acute compartment syndrome, a surgical emergency, is defined as increased pressure in an osseofascial space. The resulting reduction of capillary perfusion to that compartment requires prompt fasciotomy. Treatment delay has a poor prognosis, and is associated with muscle and nerve ischemia, resultant infarction, and late-onset contractures. OBJECTIVES: We report a case of traumatic bilateral upper limb acute compartment syndrome associated with anabolic steroids, requiring bilateral emergency fasciotomies. CASE REPORT: A 25-year-old male bodybuilder taking anabolic steroids, with no past medical history, presented to the Emergency Department 25 min after a road traffic accident. Secondary survey confirmed injuries to both upper limbs with no distal neurovascular deficit. Plain radiographs demonstrated bilateral metaphyseal fractures of the distal humeri. Within 2 h of the accident, the patient developed clinical features that were consistent with bilateral upper arm compartment syndrome. Bilateral fasciotomies of both anterior and posterior compartments were performed, confirming clinical suspicion. CONCLUSION: We suggest consideration of a history of anabolic steroid use when evaluating patients with extremity trauma.

Compartment syndrome as a spectrum of purple glove syndrome following intravenous phenytoin administration in a young male: a case report and review of literature.

Compartment syndrome is a rare complication of spectrum of purple glove syndrome, seen as a side effect of intravenous phenytoin. This involves rapid discolouration of the involved limb along with edema and sometimes blistering of the skin also. Treatment is usually conservative and rarely requires surgery. We present a case of compartment syndrome following intravenous phenytoin administration and review of literature related to the case.

[Defect coverage with myofasciocutaneous free flaps. Consequence of corticosteroid infiltration of the wrist in a patient on immunosuppressive therapy]. / Defektdeckung mit myofasziokutanem Lappen. Folge einer Kortikoidinfiltration des Handgelenks bei einer immunsuppressiv behandelten Patientin.

Intra-articular corticosteroid injection and radiation of the wrist was performed in a patient on immunosuppressive therapy. She sustained empyema and impending compartment syndrome. After fasciotomy, debridement and antibiotic therapy had been performed, we provided soft tissue coverage by a combined ALTP and muscular free flap on the vascular trunk of the descending branch of the lateral circumflex femoral artery. There were no complications and the patient is very satisfied with the outcome.

[An overview on envenomings inflicted by the Common adder (Vipera berus) and their treatment in Hungary. Facts and beliefs -- part I]. / Górcso alatt a keresztes vipera (Vipera berus) által okozott marások és kezelésük Magyarországon. Tények és hiedelmek - I. rész.

Consequences of bites by the Common adder (Vipera berus) were reviewed in this study. Patients bitten by snakes from different populations may develop variable symptoms due to geographical venom variation. The correct diagnosis of snake bites and the knowledge of the distribution of venomous snake taxa have a crucial impact on snake bite therapy. The characteristic symptoms of patients bitten by V. berus in Hungary are highlighted. The habitat characteristics, seasonal activity and the Hungarian distribution of the adder are described based on literature data, museum specimens and field observations. However, envenomings are uncommon in Hungary, the annual 3 to 4 incidents have to be taken seriously, regardless of the age and actual health condition of the patients. Contrary to beliefs persisting both among laymen and professionals, the venom of V. berus is powerful. Medical observation of the patients is necessary in the first 5 to 6 hours. Any systemic symptom or progression of the edema requires hospital admission.

Cocaine-induced rhabdomyolysis and compartment syndrome.

A man in his 30s with a history of cocaine and intranasal heroin use presented to the emergency department with severe leg pain and weakness. Physical examination findings were significant for tachycardia, absence of dorsalis pedis pulses, tense and painful calf muscles along with absence of plantar reflexes in bilateral lower extremities. Laboratory investigations were significant for positive urinary drug screen for cocaine, severe rhabdomyolysis and acute kidney injury. Given the absence of dorsalis pedis pulses in bilateral lower extremities and radiological evidence of oedematous changes in calf muscles with perimuscular oedema, a diagnosis of compartment syndrome was made. He was treated with bilateral lower extremity four-compartment fasciotomies and haemodialysis for acute kidney injury. Rhabdomyolysis has been attributed to cocaine use; however, compartment syndrome is a very rare complication, especially in the absence of trauma or prolonged immobilisation.

Compartment syndrome as a rare complication of iloprost infusion for peripheral vascular disease.

We report a case of acute compartment syndrome associated with the use of iloprost in the treatment of Buerger's disease. After a four-compartmental fasciotomy of the affected lower limb, the patient made a complete recovery.

Enoxaparin-induced bleeding resulting in compartment syndrome of the thigh: a case report.

BACKGROUND: Enoxaparin-related bleeding has usually been described as excess minor bleeding. OBJECTIVES: To describe a case of major bleeding with a compartment syndrome secondary to enoxaparin. The utility of bedside emergency department ultrasonography as a diagnostic tool is evident. CASE REPORT: A 62-year-old patient presented with swelling and pain in the left thigh with no history of trauma. Examination revealed a swollen extremity with a tense muscle compartment. A bedside ultrasound by the emergency physician was performed, showing a large pocket of fluid accumulation. Upon aspiration, the fluid was found to be blood. Computed tomography imaging was performed, which revealed a large hematoma, with active bleeding. Subsequent angiography showed several extravasations from the profunda artery. The patient was then taken for embolization of the bleeding, and then an anterolateral fasciotomy. The patient had an increased partial thromboplastin time, and final diagnosis was compartment syndrome due to spontaneous bleeding from enoxaparin. CONCLUSIONS: Enoxaparin can spontaneously cause serious bleeding with associated compartment syndrome.

Compartment Syndrome of the Hand Induced by Peripherally Extravasated Phenylephrine.

Background: Compartment syndrome of the hand is a rare and devastating complication of peripheral intravenous extravasation. With changes in critical care research, vasoactive medications are now more frequently administered through peripheral lines in the acute setting. Methods: We present the case of a patient diagnosed with compartment syndrome of the hand secondary to phenylephrine extravasation in the setting of hypovolemic shock. Results: The use of fasciotomy compartment release and intraoperative phentolamine resulted in significant improvement in tissue perfusion postoperatively. Conclusion: With incraesed incidence of peripherally administered vasoactive medications, the hand surgeon should be aware of potential complications and treatment of compartment syndrome with urgent fasciotomy and phentolamine administration.