Noncardiogenic pulmonary edema associated with intravenous radiocontrast administration.

the head for evaluation of memory loss. She received 100 ml of diatrizoate meglumine (Angiovist 282), an intravenous RCM. The patient had never previously been exposed to RCM and within 1 mm of its administration, she complained of severe dyspnea and a sensation of fullness in her neck, as if someone were choking her. The radiologist evaluating the patient did not report evidence of facial swelling, stridor, or skin rash. Following the immediate transfer to the intensive care unit (ICU), the patient began to improve as manifested by resolution of her dyspnea and the choking feeling in her neck. Physical examination was pertinent for an initial blood pressure of 80/60 mm Hg with a pulse rate of 110 and a respiratory rate of 24 breaths per minute. Soft inspiratory rales were heard throughout the lung fields and the upper airway appeared normal. An arterial blood specimen revealed a pH of 7.37, an oxygen tension of 54 mm Hg, and a carbon dioxide tension of 31 mm Hg while receiving nasal cannula oxygen at a flow rate of 6 L/min. An electrocardiogram showed sinus tachycardia and the chest roent genogram demonstrated bilateral pulmonary edema (Fig 1). A pulmonary artery catheter was placed revealing a cardiac index of 2.4 Llmin/m°,pulmonary artery pressures of 27/1 1 mm Hg, and a pulmonary artery occlusive pressure of5 mm Hg. Hemodynamic parameters followinga 1,500-ml infusion of normal saline solution were blood pressure of 105170 mm Hg, cardiac index of 3. 1 Llmin/m°,pulmonary artery pressures of 32/19 mm Hg, and pulmonary artery occlusive pressure of 11 mm Hg. A follow-up chest roentgenogram perG)rmed 4 h after ICU admission (Fig 2) showed nearly complete resolution of the pulmonary edema, and the patient was discharged from the ICU 12 h later after showing no evidence of myocardial infarction. FIGuRE 1. Chest roentgenogram demonstrating pulmonary edema.