Abstract
Introduction
Gadolinium-based contrast agents (GBCA) are frequently used for MRI contrast studies. We report a case of pulmonary aspiration secondary to inadvertent GBCA injection.
Case Report
A 12-year-old female with a past medical history significant for mitochondrial disorder, bronchial asthma, autism, recurrent urinary tract infection, epilepsy, developmental delay, dysautonomia, and thrombocytopenia was scheduled for a contrast-enhanced MRI study using gadoterate meglumine for urinary incontinence. The patient was sedated and intubated in preparation for the study, during which 10 mL of gadoterate meglumine was inadvertently injected into the endotracheal tube cuff pilot line instead of intravenously. The patient remained intubated and was admitted to the intensive care unit with continuous monitoring for signs of pulmonary injury or gadolinium toxicity. She was successfully extubated approximately 24 hours later without complication.
Discussion
A variety of adverse effects attributable to parenteral GBCA exposure have been reported ranging from mild irritation to life-threatening anaphylaxis. Gadolinium deposition and storage have been implicated in a number of those adverse effects and multiple treatments modalities have been suggested, but no scientifically guided management exists.
Conclusion
This case of pulmonary aspiration secondary to inadvertent GBCA injection in a pediatric patient demonstrated no acute side effects or complications within the first 24 hours. With the wide range of adverse effects attributed to gadolinium use in the medical literature, it is difficult to predict potential future adverse effects.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Grobner T. Gadolinium--a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006;21(4):1104–8.
Ramalho J, Ramalho M, Jay M, Burke LM, Semelka RC. Gadolinium toxicity and treatment. Magn Reson Imaging. 2016;34(10):1394–8.
DOTAREM (gadoterate meglumine). [Package Insert]. Princeton, NJ, Guerbet LLC, 2017 Reference ID: 4144275. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/204781s008lbl.pdf. Accessed 5 Apr 2019.
Ramalho M, Ramalho J, Burke LM, Semelka RC. Gadolinium retention and toxicity-an update. Adv Chronic Kidney Dis. 2017;24(3):138–46.
Arlt S, Cepek L, Rustenbeck HH, Prange H, Reimers CD. Gadolinium encephalopathy due to accidental intrathecal administration of gadopentetate dimeglumine. J Neurol. 2007;254(6):810–2.
Semelka RC, Commander CW, Jay M, Burke LMB, Ramalho M. Presumed gadolinium toxicity in subjects with normal renal function: a report of 4 cases. Investig Radiol. 2016;51(10):661–5.
Rogosnitzky M, Branch S. Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Biometals. 2016;29(3):365–76.
Acknowledgements
The authors would like to gratefully acknowledge Dr. Laura Vearrier, MD, DBioethics, for her assistance in providing the images used in this submission.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Consent for publication of this case was obtained and provided to the journal in accordance with JMT policy.
Conflict of Interest
None.
Additional information
Supervising Editor: Andis Graudins, MB BS, PhD
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mostafa, A.M.T., Ershad, M., Dela Cruz, M. et al. Gadolinium Aspiration Following Inadvertent Endotracheal Tube Cuff Injection in a Pediatric Patient. J. Med. Toxicol. 15, 202–204 (2019). https://doi.org/10.1007/s13181-019-00711-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13181-019-00711-4