SHM Converge Scientific Abstract ePoster Gallery-Non-Cardiogenic Pulmonary Edema Following Gadolinium Use for Magnetic Resonance Imaging

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This case report describes a 38-year-old woman who developed non-cardiogenic pulmonary edema (NCPE) after receiving gadobutrol, a gadolinium-based contrast agent, during an outpatient pelvic MRI. She initially coughed immediately after contrast administration and then, about 15 minutes later, developed lightheadedness, worsening cough, shortness of breath, nausea, vomiting, and abdominal pain. On evaluation, she was hypotensive, mildly hypoxic, pale, and diaphoretic, raising concern for anaphylaxis.<br /><br />She was transferred to the emergency department and treated with IV methylprednisolone, diphenhydramine, ondansetron, and intravenous fluids. Workup showed leukopenia, elevated D-dimer, but normal BNP and negative cardiac enzymes. ECG and echocardiogram were normal, making cardiogenic causes less likely. Chest imaging revealed bilateral perihilar/lower lobe opacities and CT chest showed findings consistent with pulmonary edema without pulmonary embolism. She improved after receiving IV furosemide, supplemental oxygen, and supportive care, and was later discharged.<br /><br />The report emphasizes that NCPE is a rare but serious complication of gadolinium-based contrast media, occurring in a very small percentage of exposed patients. Although common adverse effects of gadolinium include nausea, dizziness, and headache, severe reactions such as pulmonary edema can occur. Because NCPE can rapidly cause acute hypoxic respiratory failure, early recognition is essential. Management is primarily supportive, including oxygen, diuresis, and sometimes non-invasive ventilation.<br /><br />The authors conclude that gadolinium contrast should be used cautiously and only when clearly indicated, with clinicians maintaining a high index of suspicion for NCPE when respiratory symptoms develop after contrast exposure.

Asset Subtitle

Danielle J.R Pope

Meta Tag

Author List Danielle J.R Pope, Fausto G. Lisung, Kemar O. Barrett, Sofia Terner, Zachary Banbury

Category Clinical Vignettes

Concept Gadolinium-Based Contrast Agents

Concept Noncardiogenic Pulmonary Edema

Concept MRI Contrast Administration

Concept Pulmonary Edema

Concept Supportive Care

Distinguished Non-Finalist

Presenter Organization Englewood Health

Presenting Author Danielle J.R Pope

Track Adult

Keywords

non-cardiogenic pulmonary edema

gadobutrol

gadolinium-based contrast agent

MRI contrast reaction

anaphylaxis

acute hypoxic respiratory failure

pulmonary edema

contrast-induced complication

supportive care

furosemide

Gadolinium-Based Contrast Agents

Noncardiogenic Pulmonary Edema

MRI Contrast Administration

Pulmonary Edema

Supportive Care