Intramuscular hemorrhage and fluid extravasation into the anterior compartment secondary to intraosseous resuscitation, the “Nicked-Cortex” sign

Abstract

Intraosseous needle access is a reliable method of vascular access used for rapid fluid resuscitation and delivery of medications in certain emergent settings. Fluid extravasation is a possible complication of intraosseous needle access that can lead to compartment syndrome. To our knowledge, imaging findings resulting from this complication have not been described. In this case report, we demonstrate conventional radiograph, computed tomography, and magnetic resonance image findings due to extravasation of resuscitation fluids following the aberrant insertion of an intraosseous needle in an unstable adult trauma patient. We also describe a new radiographic sign associated with this iatrogenic complication, the “Nicked-Cortex” sign. Keywords: Intraosseous needle, Compartment syndrome, Extravasation, “Nicked-Cortex” sign