Pneumotox » Drug » Radiocontrast media (RCM)

Radiocontrast media (RCM)

Iodinated or barium salt-based. Both the risk and consequences of developing AE is increased in those patients exposed to beta-blackers concomitantly (PMID 8102844). A large series is available at PMID 25366341

Last update : 07/05/2016

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.j Exogenous lipoid pneumonia (subacute, acute)

I.v Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

II.a Pulmonary edema, noncardiogenic (NCPE)

II.b ARDS - Acute lung injury

II.h Overload pulmonary edema (including posttransfusional (TACO))

II.i Flash (fulminate) pulmonary edema

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

IV.a Bronchospasm - Wheezing - Asthma

IV.b Bronchospasm and angioedema

IV.f Severe or catastrophic bronchospasm or asthma attack (can be fatal)

VI.e Fat/oil embolism - The FES embolism syndrome

VI.aa Lipiodol pulmonary embolism

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

X.g Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

X.n Tumor lysis syndrome (TLS)

X.ap Delayed anaphylaxis

XVIII.h Eye-catcher: Lipiodol embolism

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France