Work

A Rare Case Report of Contrast Media-induced Sympathetic Crashing Acute Pulmonary Edema

Year: 2025

Type: article

Abstract: INTRODUCTION: Sympathetic crashing acute pulmonary edema (SCAPE), also known as flash pulmonary edema or hypertensive acute heart failure, is a critical condition characterized by a rapid escalation of sympathetic outflow, excessive afterload, and worsening heart failure. Although rare, contrast media-induced pulmonary edema is a severe adverse reaction, occurring in 0.001-0.008% of patients receiving intravenous contrast and accounting for 10-20% of lethal contrast reactions. CASE REPORT: A 70-year-old male developed acute respiratory distress shortly after undergoing an outpatient, contrast-enhanced computed tomography. Despite treatment for suspected anaphylaxis, the patient's condition continued to deteriorate until a diagnosis of SCAPE was ultimately recognized. Treatment with high-dose nitroglycerin, non-invasive positive pressure ventilation (NIPPV), and eventual intubation resulted in the patient's full recovery. CONCLUSION: This report highlights the importance of recognizing SCAPE in patients presenting with sudden dyspnea after contrast administration and emphasizes the need for early intervention with NIPPV and vasodilators to reduce morbidity and mortality.

Source: Clinical Practice and Cases in Emergency Medicine

DOI: 10.5811/cpcem.38444

Authors: Clates P Adams, Christian I Wade

Institutions: Madigan Army Medical Center, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium

Language: English

Topic: Takotsubo Cardiomyopathy and Associated Phenomena

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $500