Abstract Background Extravasation of gadolinium-based contrast agents (GBCAs) during magnetic resonance imaging is a rare adverse event, with most cases resolving without significant complications. However, severe tissue injury following GBCA extravasation remains extremely rare and incompletely characterized in the existing literature. Case presentation A 58-year-old female (Chinese, Asian) with hepatocellular carcinoma and ongoing chemotherapy experienced gadopentetate dimeglumine extravasation during an abdominal magnetic resonance imaging (MRI) examination. Despite standard initial management—including immediate catheter removal, ice application, limb elevation, and topical heparinoid cream administration—the patient developed a tension blister within four hours, followed by progressive tissue necrosis and a deep cutaneous ulcer. The ulceration was further complicated by secondary infection, likely secondary to inappropriate self-management of the blister. The patient underwent a prolonged wound care regimen, culminating in complete re-epithelialization after four weeks, with no residual functional impairment. Conclusion This case underscores the potential severity of cutaneous complications resulting from GBCA extravasation, especially in high-risk patients with chemotherapy-induced vascular vulnerability or diminished tissue integrity. It emphasizes the critical importance of vigilant post-extravasation monitoring, proactive patient education to prevent inappropriate self-management of the injury, and the implementation of structured wound care protocols. Future studies are warranted to establish evidence-based preventive strategies and therapeutic guidelines for GBCA-related extravasation injuries.
Zhang et al. (Wed,) studied this question.