非イオン性ヨード造影剤により生じた非心原性肺水腫の1救命例

A Case of Survival from Severe Non-Cardiac Pulmonary Edema Caused by a Non-Ionic Contrast Media

　症例は心臓二弁置換術の既往と慢性閉塞性肺疾患（COPD）を有する68歳，男性．気道感染によるCOPDの増悪で入院．その際胸部CTで肝臓癌を指摘された．肝動脈造影・抗癌剤の動注療法が行われたが，その終了30分後より呼吸困難が出現．両上肺野に著明な肺うっ血を認めた．Drug-induced lymphocyte stimulation test（DLST）で非イオン性造影剤であるイオメプロール（イオメロン^®）が陽性であり，同剤の遅発型副作用による非心原性肺水腫と診断した．人工呼吸管理下にステロイドパルス療法，代用血漿製剤の輸液を行い軽快した．一般に非イオン性造影剤はイオン性造影剤より副作用は少ないとされるが，本例のように重篤な副作用を認めることがあり注意が必要である．

A 68-year-old man, who had had replacement of hisheart valves and chronic obstructive pulmonary disease, suffered from non-cardiogenic pulmonary edema induced by a non-ionic contrast media. He was admittedto our hospital because of acute exacerbation of hischronic obstructive pulmonary disease. Because he alsohas hepatitis type C, computed tomography wasexamined, indicating hepato-cellular carcinoma. Angiography was performed and cartinostatics were administered via the hepatic artery. About two hours afterIomeprol was infused intravenously, the patient, feltintolerable dyspnea immediately and intubation wasneeded. Chest roentgenogram revealed butterfly shadowspread on the upper lung field bilaterally but the cardiothoracic ratio did not change. We diagnosed the illnessas non-cardiogenic pulmonary edema caused by Iomeprol, because the drug-induced lymphocyte stimulationtest (DLST) showed Iomeprol to be 234%. Steroid pulsetherapy was effective. Our conclusion was that we needto be careful when using non-ionic contrast media aswell as when using ionic-contrast media.