Radiocontrast-Induced Acute Respiratory Distress Syndrome (ARDS): A Case Report

顯影劑引發之急性呼吸窘迫症候群：案例報告

曾穎凡(Ying-Fan Tseng) ； 郭順文(Shuenn-Wen Kuo) ； 李章銘(Jang-Ming Lee) ； 徐紹勛(Hsao-Hsun Hsu)

《胸腔醫學》 33卷1期 (2018/02) Pp. 43-49

摘要

Hypersensitivity to radiocontrast media is not a common clinical event, and life-threatening delayed-type hypersensitivity is even less encountered. Herein, we present the case of a 57-year-old man with idiopathic pulmonary fibrosis, who underwent coronary angiography as part of pre-lung transplant evaluation. After angiography, the patient's oxygen demand substantially escalated over time, and non-cardiogenic lung edema developed. When considering the cause, hypersensitivity seemed more likely than infection. When the patient's clinical condition deteriorated, and even mechanical ventilation and pure oxygen failed to support the patient's respiratory needs, we summoned veno-venous extracorporeal membrane oxygenation to combat acute respiratory distress syndrome, and used steroids judiciously. The patient recovered gradually and was successfully bridged to lung transplant at post-contrast day 29, after this unexpected delayed-type hypersensitivity crisis was resolved.

關鍵字

radiocontrast media ； acute respiratory distress syndrome ； hypersensitivity

並列摘要

顯影劑之過敏反應並非常見的臨床狀況，而致命之延遲性過敏反應更為臨床上所罕見。在此，我們報告的案例為一位57歲男性，診斷為原發性肺纖維化。病人為進行肺移植前評估，接受冠狀動脈造影術，術後病人的氧氣需求明顯增加，進而引發非心因性肺水腫。在釐清因果時，我們認為過敏反應比感染為更有可能之鑑別診斷。當病人病況惡化，呼吸器及純氧皆無法滿足病人的呼吸需求時，我們使用靜脈－靜脈體外膜氧合器以拮抗急性呼吸窘迫症候群，同時也審慎地使用類固醇治療。當這次非預期的延遲性過敏反應危機解除，病人逐漸康復，並於接受顯影劑施打的第二十九日後成功地接受肺臟移植。

並列關鍵字

顯影劑 ； 急性呼吸窘迫症候群 ； 過敏反應