Cordarone Extravasation Inducing Volkmann's-like Syndrome

Abstract

We report a case of Volkmann's-like syndrome occurred after an extravasation of 300 mg of cordarone administrated for a cardiac arrest.The day following the extravasation, an extensive necrosis of the skin and soft tissues occurred. The patient progressively developed a retraction of the muscles of her forearm. To the best of our knowledge this is first the reported case of an acute necrosis of the soft tissue inducing a Volkmann's-like retraction of the upper limb subsequent to a cordarone extravasation. The imaging findings are provided along with a review of the literature.

Keywords: Adverse effects; Amiodarone; Necrosis chemically induced; Skin pathology.

Figure 1

Axial T1-weighted images after injection of Gadolinium (A) and sagittal T1-weighted images before contrast injection (B). Multiple confluent avascular areas of soft tissues necrosis (white asterisks) of the posterior and the anterior compartment of the forearm are observed. The large area of skin necrosis (white arrowheads) is covered with a bandage (black asterisk). Some areas of bone marrow oedema of the radius are seen near the abnormal changes of soft tissue (large white arrows).

Figure 2

X-rays performed 12 months after cordarone extravasation show a severe contracture of the upper limb involving elbow, wrist and interphalangeal joints of the fingers. Notice the atrophy of the soft tissues of the forearm (reduced diameter of the forearm and hypo-density due to the fatty-fibrous atrophy).