Transient angioedema of small bowel secondary to intravenous iodinated contrast medium

Abstract

We report the clinical details and imaging findings of a case of transient angioedema of the small bowel following intravenous administration of non-ionic iodinated contrast material in a 17 year old female with no predisposing risk factors. Findings included long segment, symmetric, circumferential, low-density, bowel wall thickening involving the duodenum, jejunum, and most of the ileum on computed tomography scan obtained at 7 min following intravenous contrast material injection. This entity is self-limiting with a favourable clinical outcome and requires no specific treatment but only aggressive clinical monitoring.

Keywords

Anaphylaxis - CECT - transient angioedema

• References

• 1 Wang CL, Cohan RH, Ellis JH, Caoili EM, Wang G, Francis IR. Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. AJR Am J Roentgenol 2008;191:409-15.
• 2 Hu, XH, Gong XY, Hu P. Transient small bowel angioedema due to intravenous iodinated contrast media. World J Gastroenterol 2012;18:999-1002.
• 3 Adapted from the ACR Manual on Contrast Media-Version 9, 2013. Published by the American College of Radiology. Available from: http://www.acr.org/quality-safety/resources/contrast-manual. [Last accessed on 2014 Mar 10].
• 4 Polger M, Kuhlman JE, Hansen FC 3 rd , Fishman EK. Computed tomography of angioedema of small bowel due to reaction to radiographic contrast medium. J Comput Assist Tomogr 1988;12:1044-6.
• 5 Kim SH, Cho JY, Lim HK. CT findings of isolated small bowel angioedema due to iodinated radiographic contrast medium reaction. Abdom Imaging 1999;24:117-9.
• 6 Chen CK, Chang HT, Chen CW, Lee RC, Sheu MH, Wu MH, et al. Dynamic computed tomography of angioedema of the small bowel induced by iodinated contrast medium: Prompted by coughing-related motion artifact. Clin Imaging 2012;36:386-9.
• 7 De Backer AI, De Schepper AM, Vandevenne JE, Schoeters P, Michielsen P, Stevens WJ. CT of angioedema of the small bowel. AJR Am J Roentgenol 2001;176:649-52.
• 8 Macari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: Observations at MDCT and CT enterography. AJR Am J Roentgenol 2007;188:1344-55.
• 9 Sinha R, Murphy P, Sanders S, Ramachandran I, Hawker P, Rawat S, et al. Diagnostic accuracy of high-resolution MR enterography in Crohn′s disease: Comparison with surgical and pathological specimen. Clin Radiol 2013;68:917-27.
• 10 Sinha R, Rajesh A, Rawat S, Rajiah P, Ramachandran I. Infections and infestations of the gastrointestinal tract. Part 1: Bacterial, viral and fungal infections. Clin Radiol 2012;67:484-94.