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Bone Case 11 Answers

1) Can you explain the unusual appearances?

There is obvious extravasation in the left antecubital fossa with some scatter from the lateral abdominal wall. There are two curvilinear areas of uptake in the upper arm with 4 focal areas of highly raised uptake around the left shoulder and axilla.

The features are that of extravasation with uptake into lymph vessels and subsequently, uptake in the axillary and subclavian lymph nodes. It should not be confused with uptake into lymph nodes affected by malignant disease or bony metastases.

Extravasation is more common in the follow scenarios

Patients with altered circulation (venous thrombosis or insufficiency, previous radiation therapy, previous axillary lymph node dissection or vein graft harvesting); Hand, wrist, foot, and ankle IV sites; Indwelling IV lines that have been in place > 24 hours or Multiple injections into the same vein

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The text is entirely the opinion of the author and does not necessarily reflect that of RUH NHS Trust or the Bristol Radiology Training Scheme. Website content devised by Paul McCoubrie.