非イオン性ヨード造影剤により非心原性肺水腫，肺胞出血を来したくも膜下出血の1例

Non-cardiogenic Pulmonary Edema Induced by Non-ionic Radiographic Contrast Media During the Coil Embolization for a Ruptured Cerebral Aneurysm

Ⅰ．はじめに

　ヨード系造影剤を用いた造影検査は，昨今の脳神経外科診療において必要不可欠な検査である．脳血管造影，3D-CT angiographyなどはもとより，脳血管内治療手法の確立および臨床現場における急速な普及に伴い，今後さらにヨード系造影剤の使用頻度の増加が見込まれる．

　今回，われわれは脳血管内治療後にヨード系造影剤による非心原性肺水腫を来したくも膜下出血の1例を経験したので，同造影薬剤の副作用に関した文献的考察を加え，その臨床経過を報告する．

We describe a 44 year-old woman,who presents a non-cardiogenic pulmonary edema caused by non-ionic radiographic contrast medium. She suffered from subarachnoid hemorrhage due to dissecting aneurysm of right vertebral artery. Cerebral angiography followed by coil embolization for the aneurysm was performed. During the interventional procedure,saturation of blood oxygen suddenly declined and chest X-ray photography obviously revealed pulmonary edema. At first we dealt with it as neurogenic phenomenon but subsequently interpreted it to non-cardiogenic pulmonary edema induced by radiographic contrast medium,since intra-arterial injection of contrast medium at follow-up angiography led the symptoms into more fulminant status. Intensive care including endotracheal intubation and continuous positive airway pressure ventilation consequently achieved complete remission and the patient discharged without any sequelae.

　Although low osmolar,non-ionic contrast medium has been regarded as relatively safe,severe reaction such as dyspnea,hypotension and cardiac arrest could emerge at certain intervals. We must perceive the adverse effects of it because the usage of contrast medium will dramatically increase with development of diagnostic radiographical methodology and interventional neurosurgery.