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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.

Intramural collection caused by contrast extravasation into the ascending aortic wall