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Everything you need to know about Computed Tomography (CT) & CT Scanning


Reactions and Complications

question1. How often do contrast reactions occur to IV contrast? Are there patients at increased risk?
question2. Although most iodinated contrast reactions are typically mild, what is the long term sequelae to the patient who gets a reaction?
question3. Are there specific patients or risk factors that make it more likely to get a contrast reaction?
question4. Will faster injection rates (5 cc/sec vs. 1 cc/sec) result in an increased incidence of contrast reactions?
question5. What are the categories of contrast reactions?
question6. Death is one of the potential complications of IV contrast. How often does this occur?
question7. What are the risks of IV contrast in terms of renal failure (CIN)? How often does CIN occur? How we prevent CIN?
question8. Who can not get IV contrast material?

Allergic Reactions

question

1. Part 1: Can a patient get a rash from IV contrast? Can it occur 24-36 hours post CT study?

Part 2: How do you treat the rash?

question2. Is it possible for a patient to get a delayed reaction to IV contrast?
questionYes. Delayed reactions occur from more than 30-60 minutes post injection to 1 week post injection. The majority occur between 6 and 12 hours.

"Delayed Adverse Reactions to contrast media are not rare but are often not recognized as being linked to contrast administration and may be falsely ascribed to other drugs, These side effects are problematic because the patient is usually without medical supervision."

Delayed Adverse Reactions to Parental Administration of Iodinated Contrast Media
Egbert RE et al.
AJR 2014; 203:1163-1170


"Immediate reactions occur at the time of injection to 1 hour after contrast administration, with most occurring within the first 5 minutes. These reactions may be either allergiclike or chemotoxic."

Delayed Adverse Reactions to Parental Administration of Iodinated Contrast Media
Egbert RE et al.
AJR 2014; 203:1163-1170


"Delayed reactions are defined as an adverse event occurring from more than 30-60 minutes to 1 week after the administration of contrast media. The majority of these reactions have been shown to occur between 6 and 12 hours after contrast administration."

Delayed Adverse Reactions to Parental Administration of Iodinated Contrast Media
Egbert RE et al.
AJR 2014; 203:1163-1170


"The ACR states that most cases of DARs are self limited and require no or minimal treatment. In cases of moderate or severe reactions that are progressive or widespread the ACR recommends antihistamines, corticosteroids, or both for skin manifestations; antipyretics for fever; antiemetic's for nausea; and fluid resuscitation for hypotension."

Delayed Adverse Reactions to Parental Administration of Iodinated Contrast Media
Egbert RE et al.
AJR 2014; 203:1163-1170


"A delayed reaction is defined as a reaction which occurs 1 hour to 1 week after contrast injection, which is predominately skin reaction. Iso-osmolar non-ionic contrast media have higher incidence of delayed adverse reactions."

Adverse reactions to Intravenous Iodinated Contrast Media: A Primer for Radiologists
Namasivayam S et al.
Emerg Radiol (2006)12; 210-215

question3. What if a patient is allergic to IV contrast material?
question

4. Part 1: What patients are allergic to IV contrast?

Part 2: Can we premedicate these patients and if yes what is our premedication protocol?

question5. Our patient needs the study now. What else can we do?
question6. The patient is allergic to shellfish or crabs. Can they get a IV contrast?

Extravasation

question1. What is contrast extravasation and how often does it occur?
question2. How do you prevent contrast extravasation?
question

3. Part 1: How do we treat contrast extravasation when it happens?

Part 2: Is cold compresses the rule or hot compresses?
question4. What if extravasation does occur. How often are there severe complication?

 

© 1999-2020 Elliot K. Fishman, MD, FACR. All rights reserved.