DOI QR코드

DOI QR Code

A Delayed, Unusual Non-Cardiogenic Pulmonary Edema after Intravascular Administration of Non-Ionic, Low Osmolar Radiocontrast Media for Coronary Angiography

  • Kang, Min-Ho (Division of Cardiology, Department of Medicine, Seoul Paik Hospital, Inje University School of Medicine) ;
  • Nah, Jong-Chun (Division of Cardiology, Department of Medicine, Seoul Paik Hospital, Inje University School of Medicine)
  • Published : 2013.07.30

Abstract

Non-cardiogenic pulmonary edema (NCPE) is a rare adverse reaction to iodinated radiocontrast media (RCM), in which all previous cases were immediate reactions. A 56-year-old male was given iopamidol, a non-ionic, low osmolar RCM, during coronary artery angiography. He developed pulmonary edema and fever a day after the procedure. Despite diuretic therapy, the patient's pulmonary edema worsened and his high fever persisted. The patient's pulmonary edema was eventually resolved with intravenous steroid treatment. We interpreted the patient's condition as NCPE manifesting as a delayed reaction to RCM. To our knowledge, our case is the first to show NCPE as a delayed hypersensitivity reaction.

Keywords

References

  1. Brockow K. Immediate and delayed reactions to radiocontrast media: is there an allergic mechanism? Immunol Allergy Clin North Am 2009;29:453-68. https://doi.org/10.1016/j.iac.2009.04.001
  2. Brockow K, Christiansen C, Kanny G, et al. Management of hypersensitivity reactions to iodinated contrast media. Allergy 2005;60:150-8. https://doi.org/10.1111/j.1398-9995.2005.00745.x
  3. Namasivayam S, Kalra MK, Torres WE, Small WC. Adverse reactions to intravenous iodinated contrast media: a primer for radiologists. Emerg Radiol 2006;12:210-5. https://doi.org/10.1007/s10140-006-0488-6
  4. Nayak KR, White AA, Cavendish JJ, Barker CM, Kandzari DE. Anaphylactoid reactions to radiocontrast agents: prevention and treatment in the cardiac catheterization laboratory. J Invasive Cardiol 2009;21:548-51.
  5. Bellin MF, Stacul F, Webb JA, et al. Late adverse reactions to intravascular iodine based contrast media: an update. Eur Radiol 2011;21:2305-10. https://doi.org/10.1007/s00330-011-2200-9
  6. Webb JA, Stacul F, Thomsen HS, Morcos SK; Members Of The Contrast Media Safety Committee Of The European Society Of Urogenital Radiology. Late adverse reactions to intravascular iodinated contrast media. Eur Radiol 2003;13:181-4. https://doi.org/10.1007/s00330-003-1874-z
  7. Christiansen C. Late-onset allergy-like reactions to X-ray contrast media. Curr Opin Allergy Clin Immunol 2002;2:333-9. https://doi.org/10.1097/00130832-200208000-00007
  8. Christiansen C, Pichler WJ, Skotland T. Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations. Eur Radiol 2000;10:1965-75. https://doi.org/10.1007/s003300000543
  9. Goldsmith SR, Steinberg P. Noncardiogenic pulmonary edema induced by nonionic low-osmolality radiographic contrast media. J Allergy Clin Immunol 1995;96(5 Pt 1):698-9. https://doi.org/10.1016/S0091-6749(95)70272-5
  10. Bristedt P, Tylén U. Pulmonary edema following intravenous injection of nonionic low-osmolar contrast medium--appearance on HRCT. A case report. Acta Radiol 1998;39:81-3. https://doi.org/10.1080/02841859809172155
  11. Nakajima T, Takahashi T, Umezawa K, Shimizu K, Okada H, Kaneko U. [Non-cardiogenic pulmonary edema induced by non-ionic radiographic contrast media during the coil embolization for a ruptured cerebral aneurysm]. No Shinkei Geka 2005;33:703-7.
  12. Paul RE, George G. Fatal non-cardiogenic pulmonary oedema after intravenous non-ionic radiographic contrast. Lancet 2002;359:1037-8. https://doi.org/10.1016/S0140-6736(02)08068-6
  13. Hauggaard A. Non-cardiogenic pulmonary oedema after intravenous administration of non-ionic contrast media. Acta Radiol 1996;37:823-5. https://doi.org/10.3109/02841859609177723
  14. Newman B. Delayed adverse reaction to nonionic contrast agents. Pediatr Radiol 2001;31:597-9. https://doi.org/10.1007/s002470100483
  15. Ramesh S, Reisman RE. Noncardiogenic pulmonary edema due to radiocontrast media. Ann Allergy Asthma Immunol 1995;75:308-10.

Cited by

  1. Non-cardiogenic pulmonary oedema caused by iodine contrast medium vol.13, pp.12, 2020, https://doi.org/10.1136/bcr-2020-239016