1
|
Chakeri Z, Nabipoorashrafi SA, Baruah D, Ballard DH, Chalian M, Mazaheri P, Hall NM, Desouches S, Chalian H. Contrast Reactions and Approaches to Staffing the Contrast Reaction Management Team. Acad Radiol 2024:S1076-6332(24)00354-4. [PMID: 38876842 DOI: 10.1016/j.acra.2024.05.042] [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: 01/19/2024] [Revised: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
RATIONALE AND OBJECTIVES Managing contrast reactions is critical as contrast reactions can be life-threatening and unpredictable. Institutions need an effective system to handle these events. Currently, there is no standard practice for assigning trainees, radiologists, non-radiologist physicians, or other non-physician providers for management of contrast reaction. MATERIALS AND METHODS The Association of Academic Radiologists (AAR) created a task force to address this gap. The AAR task force reviewed existing practices, studied available literature, and consulted experts related to contrast reaction management. The Society of Chairs of Academic Radiology Departments (SCARD) members were surveyed using a questionnaire focused on staffing strategies for contrast reaction management. RESULTS The task force found disparities in contrast reactions management across institutions and healthcare providers. There is a lack of standardized protocols for assigning personnel for contrast reaction management. CONCLUSION The AAR task force suggests developing standardized protocols for contrast reaction management. The protocols should outline clear roles for different healthcare providers involved in these events.
Collapse
Affiliation(s)
- Zahra Chakeri
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.)
| | - Seyed Ali Nabipoorashrafi
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.)
| | - Dhiraj Baruah
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA (D.B.)
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA (D.H.B., P.M.)
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.)
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA (D.H.B., P.M.)
| | - Neal M Hall
- Mercer University School of Medicine, Savannah, Georgia, USA (N.M.H.)
| | - Stephane Desouches
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA (S.D.)
| | - Hamid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.).
| |
Collapse
|
2
|
Nakamura G, Ozaki M, Yasuda Y, Yoshida T, Inoue T. Radiocontrast Medium-Induced Kounis Syndrome in a Dialysis Patient: A Case Report. Cureus 2024; 16:e60014. [PMID: 38854232 PMCID: PMC11162515 DOI: 10.7759/cureus.60014] [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: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Kounis syndrome is defined as the concurrence of acute coronary syndrome and a condition related to mast cell activation, including anaphylaxis and anaphylactoid. A 58-year-old male hemodialysis patient underwent enhanced computed tomography (CT) using the radiocontrast medium, iopamidol for investigation of a kidney tumor. Two minutes after the administration of iopamidol, he developed respiratory symptoms and chest pain. Five minutes after that, disturbed consciousness and low blood pressure were observed. On the other hand, he did not demonstrate urticaria and swelling of the skin. A 12-lead electrocardiogram (ECG) and echocardiogram suggested the presence of cardiac ischemia. Therefore, he was diagnosed with Kounis syndrome caused by radiocontrast media. Eighteen minutes after this, he received an intramuscular injection of adrenaline (0.3 mg), and his vital signs stabilized and his ECG, echocardiogram, and symptoms improved. Without undergoing emergency coronary angiography (CAG), he was hospitalized and closely monitored. The next day, his symptoms had not worsened, and he underwent hemodialysis at his local hospital. The allergen radiocontrast media could be injurious and not sufficiently excreted if administrated for patients on weekly hemodialysis with radiocontrast medium-induced Kounis syndrome manifesting; hence, indication for emergency CAG in radiocontrast medium-induced Kounis syndrome should be cautiously evaluated by close observation.
Collapse
Affiliation(s)
- Genki Nakamura
- Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, JPN
| | - Masayuki Ozaki
- Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, JPN
| | - Yuma Yasuda
- Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, JPN
| | - Takuya Yoshida
- Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, JPN
| | - Takuya Inoue
- Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, JPN
| |
Collapse
|
3
|
Sun Y, Zhang J. Case Report: A case of Kounis syndrome induced by iodine contrast agent during coronary angiography. Front Cardiovasc Med 2024; 11:1355692. [PMID: 38504715 PMCID: PMC10948477 DOI: 10.3389/fcvm.2024.1355692] [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] [Received: 12/14/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Kounis Syndrome (KS), a seldom-seen adverse reaction to iodine contrast agents, has an incidence that remains unclear. At present, there are no unified guidelines for managing KS either nationally or internationally. Ioversol, a new triiodinated hypotonic nonionic contrast agent, is commonly used in cardiovascular Computed Tomography (CT) and vascular imaging for diagnostic purposes. Its principal adverse reactions encompass fever, dermatological responses, convulsions, respiratory distress, hypersensitivity reactions including KS, and acute renal injury. This paper documents a case of KS induced by an iodine contrast agent during coronary angiography and, at the same time, searches for related literature and carries out a summary analysis in an attempt to provide a dependable reference for clinicians to make accurate diagnoses and treatments.
Collapse
Affiliation(s)
| | - Jian Zhang
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
4
|
Okuda R, Utsumi S, Tanaka H, Takama T, Kakihana Y. Type III Kounis Syndrome Caused by Iodine Contrast Media After Improvement of Allergic Symptoms. Cureus 2024; 16:e55514. [PMID: 38449915 PMCID: PMC10915903 DOI: 10.7759/cureus.55514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
Kounis syndrome is an acute coronary syndrome (ACS) caused by an allergic reaction that almost always occurs immediately and simultaneously with allergic symptoms. We present a case of Kounis syndrome type III that developed after complete resolution of contrast-induced anaphylaxis in a 60-year-old man with a coronary stent placed in the proximal left anterior descending (LAD) artery branch for ischemic heart disease. Contrast-enhanced computed tomography revealed anaphylactic shock. Symptoms quickly improved with intramuscular adrenaline injection; however, chest pain appeared after approximately 30 min. ECG revealed ST-wave elevation in the precordial leads. Coronary angiography revealed acute stent thrombosis with total occlusion of the proximal LAD, and percutaneous coronary angioplasty was performed. We diagnosed Kounis syndrome based on the allergic symptoms and ACS. Because some cases of Kounis syndrome develop after anaphylactic symptoms have resolved, it is advisable to follow-up patients with allergic symptoms and pay attention to chest symptoms and ECG changes, especially when they have a history of noted or treated coronary artery disease.
Collapse
Affiliation(s)
- Ryuichiro Okuda
- Emergency and Critical Care Center, Kagoshima City Hospital, Kagoshima, JPN
- Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, JPN
| | - Shu Utsumi
- Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Hideki Tanaka
- Cardiology, National Hospital Organization Kagoshima Medical Center, Kagoshima, JPN
| | - Tatsuo Takama
- Emergency and Critical Care Center, Kagoshima City Hospital, Kagoshima, JPN
- Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, JPN
| | - Yasuyuki Kakihana
- Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, JPN
| |
Collapse
|
5
|
Youcefi HE, Abu Saadeh A, Karaca G, Kimiaei A, Safaei S, Kaya A. Exploring Variations in Etiology and Clinical Presentations of Kounis Syndrome Across Pediatric and Adult Populations: A Comprehensive Review. Cureus 2024; 16:e56249. [PMID: 38623099 PMCID: PMC11016985 DOI: 10.7759/cureus.56249] [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: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Kounis syndrome (KS), recognized as a rare yet significant form of acute coronary syndrome precipitated by allergy-mediated mechanisms, poses diagnostic challenges due to its varied clinical presentations and under-recognition. Despite its relevance across diverse populations, comprehensive insights into age-specific characteristics and management remain limited. The analysis of 420 studies yielded a total of 466 case reports of Kounis syndrome, categorized into pediatric (n = 31) and adult (n = 435) populations. After rigorous screening, 330 adult and 20 pediatric case reports were included for further analysis. Triggering factors were identified, with drugs (other) being the most prevalent in both groups. The breakdown of triggering factors, such as drugs (antibiotics), bee/wasp stings, and contrast media, was elucidated. Variations in presenting symptoms, diagnostic investigations, and treatment modalities between pediatric and adult populations were observed. Notably, all pediatric cases were diagnosed with subtype I Kounis syndrome and demonstrated favorable outcomes without any reported fatalities, whereas adult cases exhibited a broader range of Kounis subtypes. Mortality was recorded solely in adult case reports, with no fatalities reported among pediatric cases. These findings underscore the importance of understanding the nuances in the clinical presentation and management of Kounis syndrome across different age groups.
Collapse
Affiliation(s)
| | | | | | - Ali Kimiaei
- Cardiology, Bahçeşehir University, Istanbul, TUR
| | | | - Adnan Kaya
- Cardiology, Bahçeşehir University, Istanbul, TUR
| |
Collapse
|
6
|
Shankar T, Vempalli N, Asokan R, Pillai A, Infimate DJL. Stroke in a patient of anaphylaxis-a case report and brief review. Int J Emerg Med 2023; 16:74. [PMID: 37848863 PMCID: PMC10580649 DOI: 10.1186/s12245-023-00548-3] [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: 03/18/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The use of nonionic low-osmolar contrast media has significantly reduced the risk of hypersensitivity reactions. Despite this, severe reactions continue to occur unpredictably. An ischemic stroke in the setting of anaphylaxis is extremely rare. CASE REPORT A 64-year-old male with no prior allergies went into anaphylactic shock following the administration of iohexol which improved after treatment. He later developed a multi-territorial ischemic stroke. CONCLUSION An ischemic stroke in the setting of an anaphylaxis is a rare occurrence, which can be attributed to multiple factors in our patient.
Collapse
Affiliation(s)
- Takshak Shankar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Reshma Asokan
- Department of Emergency Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | | |
Collapse
|
7
|
Bonnet R, Mahmoudi A, Carrel G, Cook S. Iodinated contrast media induced Kounis syndrome during coronary angiogram: a life-threatening clinical dilemma. BMJ Case Rep 2022; 15:e245047. [PMID: 35354572 PMCID: PMC8968983 DOI: 10.1136/bcr-2021-245047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/04/2022] Open
Abstract
Kounis syndrome (KS) is a well-documented hypersensitivity vasospastic reaction induced by a variety of triggers. Clinical presentation ranges from non-specific symptoms such as dizziness and nausea to myocardial infarction. Many cases of KS were reported after the use of iodinated contrast media, mainly during radiological procedures. This report describes the case of a 46-year-old man developing coronary vasospasm and anaphylactic shock at the end of percutaneous coronary intervention. Occurrence of such pathology while performing coronary angiogram is a tricky situation for the invasive cardiologist. It requires recognising a rare syndrome and interrupting the procedure to avoid extra use of contrast media even in presence of severe coronary lesions due to vasospasm. Every interventionalist should be aware of such a presentation to recognise and react promptly when facing a potentially life-threatening clinical dilemma.
Collapse
Affiliation(s)
- Romain Bonnet
- Internal Medicine Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glane, Fribourg, Switzerland
| | - Allal Mahmoudi
- Cardiology Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland
| | - Guillaume Carrel
- Intensive Care Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland
| | - Stephane Cook
- Cardiology Department, HFR Fribourg Hopital Cantonal, Villars-Sur-Glâne, Fribourg, Switzerland
| |
Collapse
|
8
|
Wang C, Deng Z, Song L, Sun W, Fang W, Li Z. Analysis of clinical characteristics of Kounis syndrome induced by contrast media. Am J Emerg Med 2021; 52:203-207. [PMID: 34959022 DOI: 10.1016/j.ajem.2021.12.036] [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: 11/30/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Understanding the relationship between contrast agents and Kounis syndrome (KS) is mainly based on case reports. The purpose of this research is to explore the clinical characteristics of contrast media induced KS. METHODS We searched for contrast-induced KS case reports through Chinese and English databases from 1991 to October 31, 2021. RESULTS A total of 26 patients (19 men and 7 women,) were included, with a median age of 60 years (range 30-83). The contrast agents that cause KS mainly included gadolinium-based contrast agent (7 cases), iodine-containing contrast media (12 cases). KS mainly occurred within 30 min after administration and mainly manifests as chest pain and allergic reactions. Electrocardiogram (ECG) mainly showed ST elevation. Echocardiography mainly revealed normal. Coronary angiography showed normal, coronary vasospasm, stent thrombosis, occlusion and stenosis. After treatment with steroids, antihistamines and anti-ischemic therapy, 24 patients recovered completely and 2 patients died. CONCLUSIONS KS is a rare adverse reaction of contrast media. Radiologists should recognize this rare but serious disease to ensure rapid diagnosis and proper management.
Collapse
Affiliation(s)
- Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenzhen Deng
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Liying Song
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weijin Fang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
9
|
Liang HZ, Zhao H, Gao J, Cao CF, Wang WM. Epirubicin-induced Kounis syndrome. BMC Cardiovasc Disord 2021; 21:133. [PMID: 33711934 PMCID: PMC7953621 DOI: 10.1186/s12872-021-01936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging. Case presentation A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made. Conclusions Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.
Collapse
Affiliation(s)
- Hui-Zhu Liang
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Hong Zhao
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Jian Gao
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Cheng-Fu Cao
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Wei-Min Wang
- Department of Cardiology, Peking University People's Hospital, Beijing, China.
| |
Collapse
|