Non-cardiogenic pulmonary edema induced by non-ionic radiographic contrast media during the coil embolization for a ruptured cerebral aneurysm

摘要

We describe a 48(correction of 44) year-old woman, who presents a non-cardiogenic pulmonary edema caused by non-ionic radiographic contrast medium. She suffered from subarachnoid hemorrhage due to dissecting aneurysm of right vertebral artery. Cerebral angiography followed by coil embolization for the aneurysm was performed. During the interventional procedure, saturation of blood oxygen suddenly declined and chest X-ray photography obviously revealed pulmonary edema. At first we dealt with it as neurogenic phenomenon but subsequently interpreted it to non-cardiogenic pulmonary edema induced by radiographic contrast medium, since intra-arterial injection of contrast medium at follow-up angiography led the symptoms into more fulminant status. Intensive care including endotracheal intubation and continuous positive airway pressure ventilation consequently achieved complete remission and the patient discharged without any sequelae. Although low osmolar, non-ionic contrast medium has been regarded as relatively safe, severe reaction such as dyspnea, hypotension and cardiac arrest could emerge at certain intervals. We must perceive the adverse effects of it because the usage of contrast medium will dramatically increase with development of diagnostic radiographical methodology and interventional neurosurgery.