title: Intramural collection caused by contrast extravasation into the ascending aortic wall.
abstract: Cardiac catheterization is a procedure routinely performed worldwide, with an estimated amount of 61,000 coronary angioplasties performed in the UK annually. Associated mortality--in the region of 0.1-0.2%--is minimal and complication rate approximately 1.5%. The most serious complications described are embolic stroke, cardiac chamber perforation, aortic dissection, coronary occlusions or dissection, and major peripheral vascular complications, including retroperitoneal haematoma and life-threatening haemorrhage. We report the case of a 75-year old patient who had inadvertent contrast agent injection into the aortic wall, leading to a localized contrast collection within the tunica media. This complication has been described before but only in association with coronary artery dissection. It is important to diagnose and manage such a situation, as most iodinated intravascular contrast agents exert a high osmotic load and thereby lead to tissue oedema and necrosis on extravasation. We describe the management of the case and discuss relevant therapeutic strategies.
authors.affiliation: Department of Cardiovascular Surgery, St Thomas' Hospital, London, UK. rizwanattia@doctors.org.uk
authors.forename: Rizwan
authors.initials: R
authors.lastname: Attia
authors.forename: Sara
authors.initials: S
authors.lastname: Jamel
authors.forename: Christopher Aldo
authors.initials: CA
authors.lastname: Rinaldi
authors.forename: Christopher
authors.initials: C
authors.lastname: Blauth
mesh_terms: D000208:Acute Disease; D000368:Aged; D001011:Aorta; D001018:Aortic Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D001027:Aortography; D002637:Chest Pain / Q000139:chemically induced; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D013577:Syndrome; D016896:Treatment Outcome; D017540:Tunica Media / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media