Gadolinium-induced acute respiratory distress syndrome: A rare clinical entity

Abstract

Gadolinium-based magnetic resonance imaging (MRI) contrast is considered stable and safe compared to iodine-based contrast agents; however, unseen and unexpected complications may occur at any time. We present the case of a 45-year-old patient who was posted for MRI contrast of the abdomen. After a few minutes of contrast injection, the patient was found having shortness of breath, chest pain with nausea, and vomiting. Pulmonary auscultation revealed bilateral fine crepitations, but he did not develop rash or angioedema and was immediately managed with steroids and with supplemental oxygen support. However, he started desaturating and shifted to the nearby emergency department where high-resolution computed tomography (HRCT) was done and showed ground-glass opacities. Coronavirus disease (COVID) swab test was negative and the patient was shifted to intensive care unit (ICU) with the provisional diagnosis of developing acute respiratory distress syndrome (ARDS). He was managed conservatively on bilevel positive airway pressure (BiPAP) and discharged after 10 days with full recovery. There is no specific biomarker for ARDS triggered by MRI contrast, and the clinical presentation is indistinguishable from other causes. Gadolinium contrast-induced ARDS is a rare but potentially life-threatening complication that should be considered in the differential diagnosis of respiratory failure following an MRI contrast injection. It is critical to be aware of this potential complication in order to provide the best outcome for the patient’s management.