Severe Acute Cardiopulmonary Failure Related to Gadobutrol Magnetic Resonance Imaging Contrast Reaction

Guru, Pramod; Fleming, Chad J.; Tan, Hon Liang; Sanghavi, Devang; Moraes, Alice Gallo De; Barsness, Gregory W.; Wittwer, Erica D.; King, Bernard F.; Arteaga, Grace M.; Flick, Randall P.; Schears, Gregory J.

doi:10.1016/j.mayocp.2015.12.010

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…In contrast to our patient, fever was reported by some investigators [ 10 – 12 ] and was deemed to be a feature of the ARDS presentation. Patients differed with regard to disease severity, with supportive respiratory support varying from noninvasive therapies [ 10 – 14 ] to invasive mechanical ventilation [ 15 – 18 ] and venoarterial extracorporeal membrane oxygenation (VA-ECMO) [ 19 ]. In two patients [ 17 , 19 ], cardiac arrest was documented, but they recovered after cardiopulmonary resuscitation (CPR) and supportive therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Patients differed with regard to disease severity, with supportive respiratory support varying from noninvasive therapies [ 10 – 14 ] to invasive mechanical ventilation [ 15 – 18 ] and venoarterial extracorporeal membrane oxygenation (VA-ECMO) [ 19 ]. In two patients [ 17 , 19 ], cardiac arrest was documented, but they recovered after cardiopulmonary resuscitation (CPR) and supportive therapies. Notably, in our patient, we used a noninvasive respiratory support strategy identical to that described by Nguyen [ 12 ] comprising noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC), with a similar outcome.…”

Section: Discussionmentioning

confidence: 99%

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Acute respiratory distress syndrome following administration of gadolinium contrast agent: a case report

2022

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Background Gadolinium-based contrast agents are used extensively in magnetic resonance imaging to assist diagnosis of medical conditions. Despite their documented safety profile, severe adverse events do occur, and their documentation may serve to raise the awareness of the medical community. Case presentation We report the case of a 15-year-old white Latin American female patient admitted to the intensive care unit for acute respiratory distress syndrome following administration of gadolinium. She did not have rash or tongue swelling but developed hypotension responsive to fluid administration and severe hypoxemia. Chest computed tomography revealed bilateral pulmonary compromise with multiple confluent consolidations. She received methylprednisolone and noninvasive ventilatory support including bilevel positive airway pressure ventilation and high-flow nasal cannula, and underwent a rapid recovery. Conclusion Gadolinium-based contrast agent-induced acute respiratory distress syndrome, albeit rare, should be included in the differential diagnosis of respiratory failure shortly after magnetic resonance imaging, which is nowadays a frequent diagnostic procedure, potentially increasing the awareness of this serious complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute respiratory distress syndrome following administration of gadolinium contrast agent: a case report

2022

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“…Pulmonary edema can be cardiogenic or non-cardiogenic; the latter occurs as a result of increased microvascular permeability and alveolar fluid infiltration. This drug-induced ARDS is hypothesized to occur through chemical injury to the vascular endothelium which results in hypoxia and pulmonary vascular resistance from accumulation of protein-rich substances in the alveoli [7] . The exact component of gadobutrol responsible for such severe hypersensitivity reaction and ARDS is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…The hospital course was uneventful, and she was successfully extubated and discharged in a week on epinephrine-pen. There are only a few reported cases of gadolinium induced severe reactions [ 1 , 7 , [10] , [11] , [12] ]. Some of these reactions are delayed in onset, suggesting that gadobutrol-induced ARDS may occur by a mechanism other than an immediate sensitivity reaction, such as anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Delayed anaphylaxis due to gadolinium- A rare clinical scenario

Acharya

Anwar

Madala

et al. 2021

Radiology Case Reports

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Acute respiratory distress syndrome is a sudden in onset, diffuse inflammatory form of lung injury which may be associated with a variety of etiologies such as pneumonia, sepsis, aspiration, and severe trauma. Prompt recognition and treatment of acute respiratory distress syndrome is critical to reduce the associated high mortality. Severe lung injury presenting as acute respiratory distress syndrome secondary to gadolinium contrast media (gadobutrol) is rarely reported. We describe an interesting case of a 47-year-old woman who presented to the emergency department with acute respiratory failure after gadolinium administration. She was diagnosed with acute respiratory distress syndrome, was admitted to the intensive care unit due to requiring mechanical ventilation. Her condition improved with epinephrine and steroids and she was successfully extubated and discharged from the hospital in one week.

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“…In the past few years, ECMO has been described, in several case reports, to provide life-sustaining rescue therapy in patients with a variety of allergic reactions to medications. [5][6][7][8] In almost all cases, veno-arterial ECMO has been used due to the drug reaction being anaphylaxis with cardiovascular collapse. In contrast, an idiopathic allergic reaction to HCTZ is most commonly manifested as pulmonary edema and may or may not be associated with shock.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

Kane

Cohen²

2017

Perfusion

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Hydrochlorothiazide has been shown to cause rare, but serious non-cardiogenic pulmonary edema. We present a case report of a patient with apparent septic shock and acute respiratory distress syndrome (ARDS) requiring life-sustaining veno-venous extracorporeal membrane oxygenation (VV-ECMO). Upon further review of the literature and the chronology of the patient's presentation, her condition was most likely due to an immune-mediated reaction to hydrochlorothiazide. This represents the first case, to our knowledge, of such a severe reaction to hydrochlorothiazide supported with ECMO therapy.

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Severe Acute Cardiopulmonary Failure Related to Gadobutrol Magnetic Resonance Imaging Contrast Reaction

Cited by 9 publications

References 9 publications

Acute respiratory distress syndrome following administration of gadolinium contrast agent: a case report

Acute respiratory distress syndrome following administration of gadolinium contrast agent: a case report

Delayed anaphylaxis due to gadolinium- A rare clinical scenario

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

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