SESSION TYPE: Miscellaneous Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Aspiration of contrast material is one of the causes of chemical pneumonitis. Lipid soluble (barium) and water soluble (gastrografin) contrast agents can potentially cause aspiration pneumonitis. There has been a paucity of case reports of gastrografin induced aspiration pneumonitis in the literature. To our knowledge all cases of gastrografin induced pneumonitis reported were fatal. We report a case of gastrografin induced pneumonitis who survived.
CASE PRESENTATION: The patient is a 32 years old with asthma, morbid obesity(BMI:37), gastric bypass surgery in 2005 who presented for elective gastric bypass construction and hiatal hernia repair surgery. Her chest X-ray(CXR) before surgery was reported as normal. Her operative course was uneventful and a repeat CXR was unchanged. Postoperatively, her pain was controlled and pulse oximetry was 97% on 4L of oxygen via nasal cannula. A subsequent upper GI series with 100ml of full strength gastrografin was performed which showed no leakage in the Gastrointestinal(GI) tract. Approximately two hours later she developed dyspnea at rest with bilateral crackles on exam. The next 12 hours was significant for progressive hypoxemic respiratory failure and eventually mechanical intubation. A CT scan of the chest showed dense diffuse multifocal opacities involving both lung fields in favor of gastrografin pneumonitis. She was treated as acute respiratory distress syndrome with low tidal volume mechanical ventilation. She also received sedation, paralytics, vasopressors for transient hypotension, steroid therapy and empiric antibiotic coverage. The hypoxemic respiratory failure improved and the patient was successfully extubated two days later.
DISCUSSION: Aspiration pneumonitis is a serious complication of gastrointestinal studies performed with oral contrast material. Gastrografin is a water soluble contrast media preferred to barium to look for GI leaks as it is less likely to cause peritoneal complications in the presence of a perforation. Gastrografin, however, has been reported to induce pulmonary edema and fatal respiratory failure after accidental aspiration in adults. Management of respiratory failure has been supportive in these reports and largely unsuccessful in preventing fatality. Our case developed respiratory symptoms soon after gastrografin administration with subsequent worsening respiratory status within 24 hours following exposure. Fortunately, she survived with steroids, empiric antibiotics and supportive therapy only.
CONCLUSIONS: The risk of gastrografin aspiration may overweigh the benefit of a lower peritoneal inflammation risk compared to barium. In light of such a devastating complication, more inert oral contrast media may be necessary as an optimum contrast choice for GI related imaging.
1) Trulzsch DV, Penmetsa A, Karim A, Evans DA.Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography.South Med J. 1992 Dec;85(12):1255-6.
DISCLOSURE: The following authors have nothing to disclose: Pouya Mohajer, Edwin Annan, Jaspreet Ahuja, Mohammed Sharif, Arthur Sung
No Product/Research Disclosure InformationAlbert Einstein College of Medicine at Beth Israel Medical Center, New York, NY