Computed tomography images of acute iodinated contrast medium reaction
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A 58-year-old male patient underwent contrast-enhanced computed tomography (CT) for prostate cancer staging with suspicion of bone metastases. The acquisition protocol included noncontrast head CT, thoracic and abdominal CT with contrast (Iopamidol 370) in arterial and portal phases, and a successive contrast-enhanced head CT.
The medical history of the patient included an allergic food (tomatoes) reaction with glottis edema many years prior. More recently, he had undergone a prostate contrast-enhanced magnetic resonance imaging examination with no adverse reactions. According to the current guidelines developed in 2019 by the Italian Society of Medical Radiology (Società Italiana Radiologia Medica) and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva), the patient was not considered at risk for a contrast medium adverse reaction [1,2].
However, during the examination and about 7 minutes after the contrast medium injection, the head CT incidentally showed marked bilateral turbinate hypertrophy associated with diffuse thickening of the nasal and pharyngeal mucosa causing reduction of the airway lumen (Fig. 1).
Head computed tomography (CT) images. (A, B) Axial and coronal noncontrast head CT. (C, D) Axial and coronal contrast-enhanced head CT. A diffuse thickening of the nasal and pharyngeal mucosa is highlighted (dotted circles), with consequent reduction of the lumen of the airways associated with a marked and bilateral hypertrophy of the turbinates.
With the suspicion of acute iodinated contrast medium reaction (AICMR), the patient was promptly examined; he complained about mild rhinitis with nasal congestion. No glottis edema, significant respiratory symptoms, or skin rash occurred. The patient was treated with a combination of antihistamine (clorphenamine) and corticosteroid (betamethasone), and his clinical status quickly improved. After observation, the patient was discharged and did not complain of symptoms in the following days.
Although some cases of small bowel angioedema caused by administration of iodinated contrast medium and demonstrated by abdominal CT have been published [3,4], this is the first case of AICMR documented with a head CT. In our case, the imaging allowed us to suspect AICMR shortly before the patient complained of symptoms. Therefore, we suggest reviewing images of the nasal cavities or upper airways after contrast administration during head CT with the aim of capturing upper airway mucosal change due to allergy and examining its severity.
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Ethics statement
The patient provided consent for publication of the research details and clinical images. Anonymity is maintained and the patient is not identifiable in the images or text.
Author contributions
Conceptualization: all authors; Investigation: all authors; Writing–original draft: AT, NR; Writing–review & editing: all authors. All authors read and approved the final manuscript.
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
The authors received no financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
References
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Capsule Summary
What is already known
Acute iodinated contrast media adverse reactions represent a group of signs and symptoms well-described in the literature that may occur after administration of such material.
What is new in the current study
Imaging captured modification of the upper airway mucosa due to allergy and allowed examination of its severity. Head computed tomography analysis prompted suspicion of an acute iodinated contrast media adverse reaction shortly before the patient complained of symptoms. Therefore, we suggest image analysis of the nasal cavities and upper airways to provide useful information after administration of contrast medium.