Abstract：
BACKGROUND: Noncardiogenic pulmonary edema (NCPE) is a rare and life-threatening allergy-like reaction to the intravascular injection of a nonionic radiographic agent. We first describe a very rare case of fatal NCPE after the intravenous injection of nonionic, iso-osmolar iodine contrast media. Case presentation A 55-year-old male patient was admitted to the hospital with esophageal cancer. After the intravenous administration of 100 mL iodixanol, the patient first exhibited digestive tract symptoms, including abdominal pain, diarrhea, and vomiting, with no dyspnea, rash, itching, or throat edema. He received anti-allergy treatment, but his symptoms did not improve; instead, he further developed pulmonary edema. Arterial blood gas analysis results were as follows: pH, 7.08; PO2, 70 mm Hg; PCO2, 40 mm Hg; and SaO2, 52%. Then, the patient received emergent tracheal intubation and ventilation to assist breathing, and he was transferred to the intensive care unit (ICU) for further treatment. In the ICU, the patient developed shock and respiratory and circulatory failure; therefore, he received shock resuscitation, acidosis correction, muscle relaxants to lower the work of breathing, and cardiotonic therapy. The patient eventually died. During the ICU period, emergency bedside color ultrasound showed a diffuse B line in both lungs, and the size of the cardiac cavity was normal, but the ventricular rate was extremely fast. Chest radiography showed pulmonary edema with a normal cardiac silhouette, and the brain natriuretic peptide (BNP) level was in the normal range.
CONCLUSIONS: NCPE is a rare and critical allergy-like reaction to the use of a nonionic iso-osmolar radiocontrast contrast medium. Clinicians should pay very close attention to digestive tract manifestations during the medical observation of patients, as gastrointestinal manifestations may be the prodromal symptoms of NCPE caused by iso-osmolar contrast medium injection.
CONCLUSIONS: NCPE is a rare and critical allergy-like reaction to the use of a nonionic iso-osmolar radiocontrast contrast medium. Clinicians should pay very close attention to digestive tract manifestations during the medical observation of patients, as gastrointestinal manifestations may be the prodromal symptoms of NCPE caused by iso-osmolar contrast medium injection.
摘要：
背景：非心源性肺水肿（NCPE）是一种罕见且危及生命的过敏样反应，血管内注射非离子射线剂。我们首先描述了一个非常罕见的致命NCPE病例，等渗碘造影剂。病例介绍一名55岁的男性患者因食管癌入院。静脉注射100毫升碘克沙醇后，患者首先表现出消化道症状，包括腹痛,腹泻,呕吐,没有呼吸困难,皮疹,瘙痒,或咽喉水肿。他接受了抗过敏治疗，但是他的症状没有改善，他进一步发展为肺水肿。动脉血气分析结果如下:pH值,7.08;PO2,70mmHg;PCO2,40mmHg;和SaO2,52%。然后，患者接受了紧急气管插管和通气以辅助呼吸，他被转移到重症监护病房（ICU）接受进一步治疗。在ICU,患者出现休克，呼吸和循环衰竭；因此，他接受了休克复苏,酸中毒矫正,肌肉松弛剂来降低呼吸的工作，强心疗法.患者最终死亡。在ICU期间，急诊床边彩超显示双肺弥漫性B线,心腔大小正常,但是心室率非常快。胸片显示肺水肿，心脏轮廓正常，脑钠肽（BNP）水平在正常范围内。
结论：NCPE是使用非离子等渗放射性造影剂引起的一种罕见且严重的过敏样反应。临床医生在对患者进行医学观察时,应密切关注消化道表现,由于胃肠道表现可能是等渗造影剂注射引起的NCPE的前驱症状。
结论：NCPE是使用非离子等渗放射性造影剂引起的一种罕见且严重的过敏样反应。临床医生在对患者进行医学观察时,应密切关注消化道表现,由于胃肠道表现可能是等渗造影剂注射引起的NCPE的前驱症状。
