Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report
Abstract Background Noncardiogenic pulmonary edema (NCPE) is a rare and life-threatening allergy-like reaction to the intravascular injection of a nonionic radiographic agent. We first describe a very rare case of fatal NCPE after the intravenous injection of nonionic, iso-osmolar iodine contrast me...
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-022-01908-0 |
| _version_ | 1818354453517959168 |
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| author | Kun-ming Yi Xue Li |
| author_facet | Kun-ming Yi Xue Li |
| author_sort | Kun-ming Yi |
| collection | DOAJ |
| description | Abstract Background Noncardiogenic pulmonary edema (NCPE) is a rare and life-threatening allergy-like reaction to the intravascular injection of a nonionic radiographic agent. We first describe a very rare case of fatal NCPE after the intravenous injection of nonionic, iso-osmolar iodine contrast media. Case presentation A 55-year-old male patient was admitted to the hospital with esophageal cancer. After the intravenous administration of 100 mL iodixanol, the patient first exhibited digestive tract symptoms, including abdominal pain, diarrhea, and vomiting, with no dyspnea, rash, itching, or throat edema. He received anti-allergy treatment, but his symptoms did not improve; instead, he further developed pulmonary edema. Arterial blood gas analysis results were as follows: pH, 7.08; PO2, 70 mm Hg; PCO2, 40 mm Hg; and SaO2, 52%. Then, the patient received emergent tracheal intubation and ventilation to assist breathing, and he was transferred to the intensive care unit (ICU) for further treatment. In the ICU, the patient developed shock and respiratory and circulatory failure; therefore, he received shock resuscitation, acidosis correction, muscle relaxants to lower the work of breathing, and cardiotonic therapy. The patient eventually died. During the ICU period, emergency bedside color ultrasound showed a diffuse B line in both lungs, and the size of the cardiac cavity was normal, but the ventricular rate was extremely fast. Chest radiography showed pulmonary edema with a normal cardiac silhouette, and the brain natriuretic peptide (BNP) level was in the normal range. Conclusions NCPE is a rare and critical allergy-like reaction to the use of a nonionic iso-osmolar radiocontrast contrast medium. Clinicians should pay very close attention to digestive tract manifestations during the medical observation of patients, as gastrointestinal manifestations may be the prodromal symptoms of NCPE caused by iso-osmolar contrast medium injection. |
| first_indexed | 2024-12-13T19:25:40Z |
| format | Article |
| id | doaj.art-cfc587843f8840e29c52ef5d6cade2b7 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-13T19:25:40Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-cfc587843f8840e29c52ef5d6cade2b72022-12-21T23:34:03ZengBMCBMC Pulmonary Medicine1471-24662022-03-012211410.1186/s12890-022-01908-0Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case reportKun-ming Yi0Xue Li1Department of Radiology, Daping Hospital, Army Medical UniversityDepartment of Radiology, Daping Hospital, Army Medical UniversityAbstract Background Noncardiogenic pulmonary edema (NCPE) is a rare and life-threatening allergy-like reaction to the intravascular injection of a nonionic radiographic agent. We first describe a very rare case of fatal NCPE after the intravenous injection of nonionic, iso-osmolar iodine contrast media. Case presentation A 55-year-old male patient was admitted to the hospital with esophageal cancer. After the intravenous administration of 100 mL iodixanol, the patient first exhibited digestive tract symptoms, including abdominal pain, diarrhea, and vomiting, with no dyspnea, rash, itching, or throat edema. He received anti-allergy treatment, but his symptoms did not improve; instead, he further developed pulmonary edema. Arterial blood gas analysis results were as follows: pH, 7.08; PO2, 70 mm Hg; PCO2, 40 mm Hg; and SaO2, 52%. Then, the patient received emergent tracheal intubation and ventilation to assist breathing, and he was transferred to the intensive care unit (ICU) for further treatment. In the ICU, the patient developed shock and respiratory and circulatory failure; therefore, he received shock resuscitation, acidosis correction, muscle relaxants to lower the work of breathing, and cardiotonic therapy. The patient eventually died. During the ICU period, emergency bedside color ultrasound showed a diffuse B line in both lungs, and the size of the cardiac cavity was normal, but the ventricular rate was extremely fast. Chest radiography showed pulmonary edema with a normal cardiac silhouette, and the brain natriuretic peptide (BNP) level was in the normal range. Conclusions NCPE is a rare and critical allergy-like reaction to the use of a nonionic iso-osmolar radiocontrast contrast medium. Clinicians should pay very close attention to digestive tract manifestations during the medical observation of patients, as gastrointestinal manifestations may be the prodromal symptoms of NCPE caused by iso-osmolar contrast medium injection.https://doi.org/10.1186/s12890-022-01908-0Acute pulmonary edemaNoncardiogenic pulmonary edemaIodinated contrast mediumIso-osmolar contrast medium |
| spellingShingle | Kun-ming Yi Xue Li Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report BMC Pulmonary Medicine Acute pulmonary edema Noncardiogenic pulmonary edema Iodinated contrast medium Iso-osmolar contrast medium |
| title | Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report |
| title_full | Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report |
| title_fullStr | Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report |
| title_full_unstemmed | Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report |
| title_short | Fatal noncardiogenic pulmonary edema related to nonionic, iso-osmolar iodine contrast medium: one case report |
| title_sort | fatal noncardiogenic pulmonary edema related to nonionic iso osmolar iodine contrast medium one case report |
| topic | Acute pulmonary edema Noncardiogenic pulmonary edema Iodinated contrast medium Iso-osmolar contrast medium |
| url | https://doi.org/10.1186/s12890-022-01908-0 |
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