1
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Wilkerson RG, Winters ME. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema. Immunol Allergy Clin North Am 2023; 43:513-532. [PMID: 37394257 DOI: 10.1016/j.iac.2022.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Angioedema is a well-recognized and potentially lethal complication of angiotensin-converting enzyme inhibitor (ACEi) therapy. In ACEi-induced angioedema, bradykinin accumulates due to a decrease in its metabolism by ACE, the enzyme that is primarily responsible for this function. The action of bradykinin at bradykinin type 2 receptors leads to increased vascular permeability and the accumulation of fluid in the subcutaneous and submucosal space. Patients with ACEi-induced angioedema are at risk for airway compromise because of the tendency for the face, lips, tongue, and airway structures to be affected. The emergency physician should focus on airway evaluation and management when treating patients with ACEi-induced angioedema.
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Affiliation(s)
- R Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Michael E Winters
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/critcareguys
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2
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Johnson BO, Odenigbo N, Tcedilin D, Fouron P, Chowduary M. Extensive Soft Tissue Swelling in the Larynx and Hypopharynx of a Young Female Patient After Haloperidol Use: A Case Report on Angioneurotic Edema. Cureus 2023; 15:e41684. [PMID: 37575825 PMCID: PMC10413308 DOI: 10.7759/cureus.41684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Angioneurotic edema is a potentially life-threatening condition characterized by the rapid swelling of subcutaneous and submucosal tissues of the upper respiratory and gastrointestinal tracts. It may result in laryngeal edema, thus obstructing the airway, with a potentially fatal outcome if not diagnosed early. An allergic reaction typically causes it, but certain drugs can induce or contribute to the development of angioneurotic edema in rare cases. Haloperidol is one of the most commonly used antipsychotics to treat psychiatric disorders such as schizophrenia and, in the emergency room, acute delirium and acute psychosis. While it is generally well tolerated, in rare cases, individuals may experience a severe reaction in response to haloperidol administration. Here, we present the case of angioneurotic edema associated with intramuscular haloperidol use in a 29-year-old female patient with a history of bipolar disorder and no previous history of allergy. This case report aims to raise awareness among clinicians about this rare adverse reaction associated with haloperidol use.
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Affiliation(s)
- Bamidele O Johnson
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, New York City, USA
| | | | - Denis Tcedilin
- Internal Medicine, Interfaith Medical Center, New York City, USA
| | - Patrice Fouron
- Psychiatry, Interfaith Medical Center, New York City, USA
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3
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Pal NL, Fernandes Y. Intestinal Angioedema: A Mimic of an Acute Abdomen. Cureus 2023; 15:e34619. [PMID: 36891016 PMCID: PMC9986968 DOI: 10.7759/cureus.34619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/05/2023] Open
Abstract
Visceral angioedema presents with features mimicking an acute abdomen, causing a great challenge in the diagnosis of the disease thus delaying the treatment. A high degree of radiological suspicion and clinical correlation will help in identifying this less-known entity, avoiding unnecessary surgery. CT scanning is the preferred investigation, but concomitant ultrasonography improves the diagnostic efficacy of CT scanning.
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Affiliation(s)
- Nilkanth L Pal
- Department of Radiology, Goa Medical College and Hospital, Bambolim, Goa, IND
| | - Yasmin Fernandes
- Department of Radiology, Goa Medical College and Hospital, Bambolim, Goa, IND
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4
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Rosas S, Fowler A, Stodgill E, Deyo-Svendsen M, Phillips M. A Rare Case of Losartan-Induced Visceral Angioedema. J Prim Care Community Health 2023; 14:21501319231213744. [PMID: 37965705 PMCID: PMC10647941 DOI: 10.1177/21501319231213744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023] Open
Abstract
The following describes a case of isolated visceral angioedema related to an angiotensin II receptor blocker (ARB) medication. Additionally, we discuss the pathophysiology of drug-induced angioedema, various presentations that can be encountered, and the leading theorized mechanisms of how renin-angiotensin-aldosterone system (RAAS) blocking medications lead to angioedema. The goal of sharing this case is to help increase awareness of the possibility of ARB-induced angioedema and to recommend keeping visceral angioedema as part of the differential diagnosis when presented with a patient who is taking an angiotensin converting enzyme inhibitor (ACEI) or ARB medication that is experiencing gastrointestinal symptoms of unclear etiology.
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Affiliation(s)
| | - Austin Fowler
- University of Minnesota Medical School, Minneapolis, MN, USA
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5
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Huynh TNA, Hua L, Smalberger JA, James J. ACE inhibitor induced intestinal angioedema. ANZ J Surg 2022; 92:3110-3111. [PMID: 35199446 PMCID: PMC9790280 DOI: 10.1111/ans.17575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Tran Ngoc An Huynh
- Department of General SurgeryBox Hill HospitalMelbourneVictoriaAustralia,Department of AnatomyThe University of MelbourneMelbourneVictoriaAustralia
| | - Lina Hua
- Department of General SurgeryBox Hill HospitalMelbourneVictoriaAustralia
| | | | - Justin James
- Department of General SurgeryBox Hill HospitalMelbourneVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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6
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Abstract
Health care providers are likely to encounter patients with recurrent unexplained abdominal pain. Because hereditary angioedema (HAE) is a rare disease, it may not be part of the differential diagnosis, especially for patients who do not have concurrent skin swelling in addition to abdominal symptoms. Abdominal pain is very common in patients with HAE, occurring in up to 93% of patients, with recurrent abdominal pain reported in up to 80% of patients. In 49% of HAE attacks with abdominal symptoms, isolated abdominal pain was the only symptom. Other abdominal symptoms that commonly present in patients with HAE include distension, cramping, nausea, vomiting, and diarrhea. The average time from onset of symptoms to diagnosis is 6 to 23 years. Under-recognition of HAE in patients presenting with predominant gastrointestinal symptoms is a key factor contributing to the delay in diagnosis, increasing the likelihood of unnecessary or exploratory surgeries or procedures and the potential risk of related complications. HAE should be considered in the differential diagnosis for patients with unexplained abdominal pain, nausea, vomiting, and/or diarrhea who have complete resolution of symptoms between episodes. As highly effective targeted therapies for HAE exist, recognition and diagnosis of HAE in patients presenting with isolated abdominal pain may significantly improve morbidity and mortality for these individuals.
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7
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Amouei M, Momtazmanesh S, Kavosi H, Davarpanah AH, Shirkhoda A, Radmard AR. Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data. Insights Imaging 2022; 13:143. [PMID: 36057741 PMCID: PMC9440973 DOI: 10.1186/s13244-022-01284-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of intestinal vasculitis is often challenging due to the non-specific clinical and imaging findings. Vasculitides with gastrointestinal (GI) manifestations are rare, but their diagnosis holds immense significance as late or missed recognition can result in high mortality rates. Given the resemblance of radiologic findings with some other entities, GI vasculitis is often overlooked on small bowel studies done using computed tomography/magnetic resonance enterography (CTE/MRE). Hereon, we reviewed radiologic findings of vasculitis with gastrointestinal involvement on CTE and MRE. The variety of findings on MRE/CTE depend upon the size of the involved vessels. Signs of intestinal ischemia, e.g., mural thickening, submucosal edema, mural hyperenhancement, and restricted diffusion on diffusion-weighted imaging, are common in intestinal vasculitis. Involvement of the abdominal aorta and the major visceral arteries is presented as concentric mural thickening, transmural calcification, luminal stenosis, occlusion, aneurysmal changes, and collateral vessels. Such findings can be observed particularly in large- and medium-vessel vasculitis. The presence of extra-intestinal findings, including within the liver, kidneys, or spleen in the form of focal areas of infarction or heterogeneous enhancement due to microvascular involvement, can be another radiologic clue in diagnosis of vasculitis. The link between the clinical/laboratory findings and MRE/CTE abnormalities needs to be corresponded when it comes to the diagnosis of intestinal vasculitis.
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Affiliation(s)
- Mehrnam Amouei
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Sara Momtazmanesh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Hoda Kavosi
- Department of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Ali Shirkhoda
- Department of Radiological Science, University of California at Irvine, Irvine, USA
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran.
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8
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Monzon R, Jhun P. Neck stiffness and dysphagia. J Accid Emerg Med 2022; 39:553-566. [PMID: 35732302 DOI: 10.1136/emermed-2021-212070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rene Monzon
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Jhun
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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9
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Abstract
Angioedema is a well-recognized and potentially lethal complication of angiotensin-converting enzyme inhibitor (ACEi) therapy. In ACEi-induced angioedema, bradykinin accumulates due to a decrease in its metabolism by ACE, the enzyme that is primarily responsible for this function. The action of bradykinin at bradykinin type 2 receptors leads to increased vascular permeability and the accumulation of fluid in the subcutaneous and submucosal space. Patients with ACEi-induced angioedema are at risk for airway compromise because of the tendency for the face, lips, tongue, and airway structures to be affected. The emergency physician should focus on airway evaluation and management when treating patients with ACEi-induced angioedema.
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10
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Baig S, Stein R, Haymes D, Fiester P, Rao D. Imaging Review of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema of the Head and Neck. Cureus 2021; 13:e14021. [PMID: 33898114 PMCID: PMC8057747 DOI: 10.7759/cureus.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACE-i) are commonly used medications to treat hypertension and congestive heart failure. Angioedema is a well-established side effect of ACE-i and most commonly manifests as swelling of the mucosal and extra-mucosal soft tissues in the head and neck. CT with contrast is generally used to evaluate for airway compromise and to exclude other etiologies of edema. Herein we present five cases that illustrate the radiological findings specific to ACE-i-induced angioedema on enhanced CT scans.
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Affiliation(s)
- Saif Baig
- Radiology, Nassau University Medical Center, East Meadow, USA
| | - Rachel Stein
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Dalys Haymes
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Peter Fiester
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Dinesh Rao
- Neuroradiology, University of Florida Health, Jacksonville, USA
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11
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Pines JM, Poarch K, Hughes S. Recognition and Differential Diagnosis of Hereditary Angioedema in the Emergency Department. J Emerg Med 2020; 60:35-43. [PMID: 33218838 DOI: 10.1016/j.jemermed.2020.09.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/24/2020] [Accepted: 09/12/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Angioedema (AE) is a clinical syndrome marked by localized swelling of the subcutaneous layer of the skin or the submucosal layer of the respiratory or gastrointestinal tracts. While AE is commonly mediated by histamine (allergic AE), some types result from excessive bradykinin activity, including hereditary AE (HAE), acquired AE, and angiotensin-converting enzyme inhibitor-induced AE. These are less common but important to consider given different treatment requirements and potentially serious outcomes, including death from laryngeal swelling. OBJECTIVE This review describes the pathophysiology and clinical features of AE as well as the diagnosis and treatment of AE in the emergency department (ED). DISCUSSION Bradykinin-mediated AE does not respond to antihistamines and corticosteroids. By contrast, several targeted, effective therapies are available, including C1-inhibitor (C1-INH) concentrates, which replace the missing protein activity underlying some bradykinin-mediated AE, and medications that directly lessen bradykinin activity (eg, ecallantide and icatibant). Urticaria is generally absent in bradykinin-mediated AE and serves as a primary differentiating factor in the clinical diagnosis. Relevant laboratory assessments may include C1-INH levels, C1-INH function, and C4 complement. Patients with HAE or a family member can communicate their known diagnosis when presenting to the ED, and some may even bring their own medication(s) with them. Patients newly diagnosed with HAE in the ED should be referred for specialized outpatient care upon ED discharge. CONCLUSIONS There is a great need for ED clinicians to be aware of HAE, its differential diagnosis, and appropriate treatment to ensure that patients receive optimal and timely treatment.
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Affiliation(s)
| | - Kimberly Poarch
- Allergy and Asthma Research Association Research Center, Dallas, Texas
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12
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Kamalian S, Avery L, Lev MH, Schaefer PW, Curtin HD, Kamalian S. Nontraumatic Head and Neck Emergencies. Radiographics 2020; 39:1808-1823. [PMID: 31589568 DOI: 10.1148/rg.2019190159] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Head and neck imaging is an intimidating subject for many radiologists because of the complex anatomy and potentially serious consequences of delayed or improper diagnosis of the diverse abnormalities involving this region. The purpose of this article is to help radiologists to understand the intricate anatomy of the head and neck and to review the imaging appearances of a variety of nontraumatic head and neck conditions that bring patients to the emergency department, including acute infectious and inflammatory diseases and acute complications of head and neck neoplasms. These conditions are presented in five sections on the basis of their primary location of involvement: the oral cavity and pharynx, neck, sinonasal tract, orbits, and ears. Important anatomic landmarks are reviewed briefly in each related section.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Shervin Kamalian
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Laura Avery
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Michael H Lev
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Pamela W Schaefer
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Hugh D Curtin
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
| | - Shahmir Kamalian
- From the Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, Blake SB Rm 0029A, Boston, MA 02114 (Shervin Kamalian, L.A., M.H.L., P.W.S., Shahmir Kamalian); and Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Mass (H.D.C.)
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13
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Cunqueiro A, Gomes WA, Lee P, Dym RJ, Scheinfeld MH. CT of the Neck: Image Analysis and Reporting in the Emergency Setting. Radiographics 2019; 39:1760-1781. [PMID: 31589582 DOI: 10.1148/rg.2019190012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. In the emergency department setting, CT is performed to investigate acute infectious or inflammatory symptoms and chronic processes. With few exceptions, neck CT should be performed with intravenous contrast material, which accentuates abnormally enhancing phlegmonous and neoplastic tissues and can be used to delineate any abscesses or necrotic areas. As part of the evaluation, the vascular structures and aerodigestive tract must be scrutinized, particularly for patency. Furthermore, although the patient may present because of symptoms that suggest non-life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. With a focus on the emergency setting, the authors propose using an approach to interpreting neck CT findings whereby 12 areas are systematically evaluated and reported on: the cutaneous and subcutaneous soft tissues, aerodigestive tract and adjacent soft tissues, teeth and periodontal tissues, thyroid gland, salivary glands, lymph nodes, vascular structures, bony airspaces, cervical spine, orbits and imaged brain, lung apices, and superior mediastinum. The use of a systematic approach to interpreting neck CT findings is essential for identifying all salient findings, recognizing and synthesizing the implications of these findings to formulate the correct diagnosis, and reporting the findings and impressions in a complete, clear, and logical manner.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Alain Cunqueiro
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - William A Gomes
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Peter Lee
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - R Joshua Dym
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Meir H Scheinfeld
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
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14
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Hypovolemic Shock Caused by Angiotensin-Converting Enzyme Inhibitor-Induced Visceral Angioedema: A Case Series and A Simple Method to Diagnose this Complication in the Emergency Department. J Emerg Med 2018; 54:375-379. [DOI: 10.1016/j.jemermed.2017.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/28/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
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15
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Extensive Cervico-Thoraco-Abdominal Attacks of Angioedema: CT Diagnosis in Two Unusual Cases. J Belg Soc Radiol 2017; 101:22. [PMID: 30039014 PMCID: PMC5854334 DOI: 10.5334/jbr-btr.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Angioedema (AE) classically manifests as an acute transient swelling of extra-visceral spaces, subcutaneous and submucosal tissues. Sometimes it may be a life-threatening condition. The causes are numerous, and the common denominator is an increased vascular permeability allowing diffusion or extravasation of fluid from the vascular bed to the interstitial space. The severity of AE is related to the cause, body location, and extension. We hereby report two very unusual cases characterized by a massive attack of AE from the left cervical area to the pelvis through the length of the mediastinum and axial posterior retroperitoneum. The diagnosis was established by CT. The first case was found related to drug intake, and the second appeared idiopathic.
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16
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Palmquist S, Mathews B. Isolated intestinal type angioedema due to ACE-inhibitor therapy. Clin Case Rep 2017; 5:707-710. [PMID: 28469880 PMCID: PMC5412761 DOI: 10.1002/ccr3.925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 11/07/2022] Open
Abstract
A 42-year-old woman presents with abdominal pain after taking her first dose of lisinopril. Visceral angioedema was diagnosed based on clinical suspicion and abdominal computed tomography (CT). Awareness of this rare side effect of a common medication is key to avoid delays in diagnosis and unnecessary procedures.
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Affiliation(s)
| | - Benji Mathews
- Health Partners & University of Minnesota Medical School St. Paul MN
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17
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Une cause rare de douleur abdominale aiguë récidivante. Rev Med Interne 2016; 37:716-717. [DOI: 10.1016/j.revmed.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/23/2015] [Indexed: 11/23/2022]
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18
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Brea Álvarez B, Tuñón Gómez M, Esteban García L, García Hidalgo C, Ruiz Peralbo R. Nontraumatic head and neck emergencies: A clinical approach. Part 1: Cervicofacial swelling, dysphagia, and dyspnea. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea. RADIOLOGIA 2016; 58:329-42. [PMID: 27520826 DOI: 10.1016/j.rx.2016.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/23/2022]
Abstract
Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients.
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20
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Tomita H, Yamashiro T, Ikeda H, Fujikawa A, Kurihara Y, Nakajima Y. Fluid collection in the retropharyngeal space: A wide spectrum of various emergency diseases. Eur J Radiol 2016; 85:1247-56. [PMID: 27235871 DOI: 10.1016/j.ejrad.2016.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/27/2016] [Accepted: 04/05/2016] [Indexed: 01/01/2023]
Abstract
Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific tendinitis of the longus colli muscle. These conditions should be managed by different specialties; beginning with care in the emergency room, physicians from orthopedics, pediatrics, otolaryngology, and oncology are in charge of the treatment. Since these diseases demonstrate similar fluid collections in the RPS on computed tomography (CT) and magnetic resonance imaging (MRI), the radiologist's diagnosis based on the characteristic imaging findings is very important to identify the primary disease. Also, since some of the diseases require immediate surgical intervention to avoid life-threatening mediastinitis or airway obstruction, radiologists must distinguish these diseases correctly and provide recommendations for their management to physicians. Understanding clinical features and imaging findings of these fluid collections in the RPS is crucial for the best care.
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Affiliation(s)
- Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Hirotaka Ikeda
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Yoshiko Kurihara
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
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Iturri Clavero F, González Uriarte A, Tamayo Medel G, Martínez Ruíz A, Manuel Gamboa Setién P. [Some comments to the letter "Controversy to use icatibant for prophylaxis in angioedema"]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:544-545. [PMID: 26100456 DOI: 10.1016/j.redar.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 06/04/2023]
Affiliation(s)
- F Iturri Clavero
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
| | - A González Uriarte
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - G Tamayo Medel
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España; Departamento de Farmacología, Universidad del País Vasco, Leioa, Vizcaya, España
| | - A Martínez Ruíz
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España; Facultad de Medicina y Odontología HUC, Centro doctorado, Departamento de Cirugía, Radiología y Medicina Física, Universidad del País Vasco, Leioa, Vizcaya, España
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Romeu Vilar D, López Rey D. Angioedema de intestino delgado secundario a inhibidor de la enzima convertidora de la angiotensina. RADIOLOGIA 2015; 57:449-50. [DOI: 10.1016/j.rx.2015.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/29/2014] [Accepted: 01/09/2015] [Indexed: 11/26/2022]
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Fatal laryngeal angioedema: a case report and a workup of angioedema in a forensic setting. Forensic Sci Med Pathol 2015; 11:558-63. [PMID: 26242774 DOI: 10.1007/s12024-015-9701-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
Angioedema is an episodic swelling of the deep dermis, subcutis, and/or submucosal tissue due to an increase in local vascular permeability. Swelling may involve skin, respiratory, and gastrointestinal tracts. The most commonly involved areas are the periorbital region and the lips. Here we report a case of a fatal laryngeal obstruction due to angioedema likely caused by an angiotensin-converting-enzyme inhibitor. The decedent, a 58-year-old man, was witnessed developing sudden facial swelling and acute respiratory difficulties quickly followed by unresponsiveness. His past medical history suggested that this was his second episode of angioedema without urticaria. Postmortem examination revealed a complete laryngeal obstruction in the absence of infection, neoplasm, or autoimmune disease. Postmortem computed tomography of the head and neck showed a complete obstruction of the upper airway. Based on the current understanding of the pathophysiology of different types of angioedema, we will suggest a workup of angioedema without urticaria in the forensic setting and offer readers resources they can use in their practice.
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