Dynamic computed tomography of angioedema of the small bowel induced by iodinated contrast medium: prompted by coughing-related motion artifact

Chen, Chun Ku; Chang, Hsiao Ting; Chen, Chi-Wen; Lee, Rheun‐Chuan; Sheu, Ming-Huei; Wu, Mei-Han; Chou, Hsiao Ping; Shen, Yen Chun; Chiu, Nai‐Chi; Chang, Cheng Yen

doi:10.1016/j.clinimag.2011.10.005

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…9, 10, and 11). In addition, a case of small bowel angioedema triggered by intravenous iodinated contrast medium has been reported [21]. Gastrointestinal involvement of angioedema clinically presents as acute abdominal pain, nausea, vomiting, diarrhea, and various degrees of obstruction.…”

Section: Introductionmentioning

confidence: 99%

Radiologic manifestations of angioedema

et al. 2014

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ObjectivesThe purpose of this pictorial review is to present imaging findings of angioedema involving the various organs.ConclusionThe role of imaging for patients with angioedema includes the evaluation of the upper airway for obstruction and the exclusion of other possible aetiologies, such as neoplastic or infectious processes. Glossomegaly is a common finding of head and neck angioedema. Angioedema may involve organ systems beyond the superficial regions and the head and neck including the gastrointestinal and genitourinary tracts. Angioedema of the visceral organs is often accompanied by adjacent fluid, and it is commonly diffuse or concentric but can also be multifocal and asymmetric.Teaching PointsThe evaluation of the upper airway obstruction is important for head and neck angioedema.Glossomegaly with decreased attenuation is common in head and neck angioedema.Angioedema of the visceral organs can be multifocal and asymmetric.Angioedema of the visceral organs is often accompanied by adjacent fluid.It is important to include clinical and laboratory findings for the diagnosis of angioedema.

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Section: Introductionmentioning

confidence: 99%

Radiologic manifestations of angioedema

et al. 2014

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“…In the subsequent reports of ICM-induced bowel angioedema, the patients showed no or mild abdominal symptoms such as abdominal discomfort or vomiting, and CT images demonstrated well-contrasted transient bowel wall thickening; however, hypoattenuating submucosal edema was not clear in any of those reports. [5][6][7][9][10][11] Computed tomography images of these reports seemed to show thickening of the folds due to a marked increase in blood flow rather than the increased fluid in the submucosa typically observed on CT images of hereditary angioedema, suggesting a different mechanism or a weak manifestation of angioedema. Although there is room for discussion regarding the mechanism of this bowel wall thickening, this study showed a significant association between bowel wall thickening and nausea/vomiting after ICM administration, which is most likely an adverse effect of the contrast agent.…”

Section: Discussionmentioning

confidence: 77%

“…In the first case report of ICM-induced bowel angioedema by Polger et al, 8 the patient presented with severe abdominal pain, and CT images 4 hours later showed marked hypoattenuating submucosal edema and ascites. In the subsequent reports of ICM-induced bowel angioedema, the patients showed no or mild abdominal symptoms such as abdominal discomfort or vomiting, and CT images demonstrated well-contrasted transient bowel wall thickening; however, hypoattenuating submucosal edema was not clear in any of those reports 5–7,9–11 . Computed tomography images of these reports seemed to show thickening of the folds due to a marked increase in blood flow rather than the increased fluid in the submucosa typically observed on CT images of hereditary angioedema, suggesting a different mechanism or a weak manifestation of angioedema.…”

Section: Discussionmentioning

confidence: 97%

“…Although most acute adverse reactions to ICM cannot be detected by CT imaging, bowel angioedema of the small intestine may be the only visible acute adverse reaction on CT that has been reported to date. [5][6][7][8][9][10][11] The most typical finding of ICM-associated bowel angioedema is circumferential duodenal or jejunum wall swelling. There are several case reports of bowel angioedema, but only 1 report has investigated the incidence of ICM-associated bowel angioedema in a large cohort.…”

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Incidence of Bowel Wall Swelling Induced by Iodine-Contrast Media and Its Association With Gastrointestinal Manifestation

Ishii

Yamakuni

Tsuchiya

et al. 2023

J Comput Assist Tomogr

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Purpose The aim of this study was to investigate the incidence of bowel wall swelling after iodine-contrast media injection and its relationship with gastrointestinal symptoms. Methods The incidence of bowel wall swelling was examined in 75 patients who showed adverse reactions to iodine-contrast media (AR[+] group) and 75 controls without adverse reactions (AR[−] group). Bowel wall swelling was identified if there was increased wall thickness on postcontrast computed tomography when compared with precontrast computed tomography. Swelling less than 2-fold of the original wall thickness was defined as grade 1 bowel angioedema, and swelling more than 2-fold was defined as grade 2. Results The incidence of bowel wall swelling was significantly higher in the AR(+) group (26.6%) than in the AR(−) group (10.6%) (P = 0.01). Grade 1 bowel wall swelling was observed in 12.0% and 10.7% of AR(+) and AR(−) groups, respectively, whereas grade 2 was observed in 14.7% and 0%, respectively. Bowel wall swelling was observed in the duodenum and jejunum but not in the stomach, ileum, or colon in any patient in either group. In the AR(+) group, nausea and/or vomiting was observed in 15 patients, among whom bowel wall swelling was observed in 9 patients (60%). The frequency of nausea and/or vomiting was significantly higher in the patients with bowel wall swelling (45.0%, 9/20) compared with those without (10.9%, 6/55). Conclusion Bowel wall swelling was more frequent and severe in patients with adverse reactions to iodine-contrast media than those without and was associated with nausea and/or vomiting.

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“…[245] The incidence of post iodinated contrast angioedema of the skin and upper airway mucosal membranes is 0.01%. [6] However, the exact incidence of bowel wall angioedema is not known as it is an underreported entity. However, we believe that the incidence of bowel wall angioedema should be similar to that.…”

Section: Discussionmentioning

confidence: 99%

Transient angioedema of small bowel secondary to intravenous iodinated contrast medium

Kulkarni

Hegde

Balani

et al. 2014

Indian Journal of Radiology and Imaging

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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.

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Dynamic computed tomography of angioedema of the small bowel induced by iodinated contrast medium: prompted by coughing-related motion artifact

Cited by 6 publications

References 12 publications

Radiologic manifestations of angioedema

Radiologic manifestations of angioedema

Incidence of Bowel Wall Swelling Induced by Iodine-Contrast Media and Its Association With Gastrointestinal Manifestation

Transient angioedema of small bowel secondary to intravenous iodinated contrast medium

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