Korean Circ J.  2013 Jul;43(7):500-503. 10.4070/kcj.2013.43.7.500.

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

• Kang MH
• Nah JC

• KMID: 2145508
• DOI: http://doi.org/10.4070/kcj.2013.43.7.500

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.

Keyword

Pulmonary edema; Hypersensitivity; Contrast media

MeSH Terms

Angiography
Contrast Media
Coronary Angiography
Coronary Vessels
Fever
Humans
Hypersensitivity
Hypersensitivity, Delayed
Iopamidol
Male
Pulmonary Edema
Contrast Media
Iopamidol

Figure

• 

  Fig. 1 The electrocardiogram shows ST-segment elevation with Q-wave formation in II, III, and aVF, and reciprocal ST-segment depression in I, aVL, and V 4-6.

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  Fig. 2 Coronary angiography reveals a critical stenosis in the mid right coronary artery (A). A drug-eluting stent was deployed (B).

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  Fig. 3 Serial chest radiographs. A: no pulmonary edema at the initial presentation. B: newly appeared bilateral alveolar infiltrates a day after the procedure. C: rather aggravated pulmonary edema despite intravenous furosemide therapy. D: slightly improving the pulmonary edema after initiation of intravenous steroid. E: complete resolution of pulmonary edema at discharge.

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