Acute lung injury following gadolinium contrast: a case report

ARDS related to gadolinium contrast is rare and there have only been five previously reported cases in adults. We describe the first case to our knowledge of pediatric acute lung injury related to gadolinium contrast administration. We report on a previously healthy 10-year-old boy in our Pediatric Intersive Care Unit who was recovering from staphylococcus aureus sepsis when he developed hypoxemic respiratory failure three hours after intravenous administration of gadolinium contrast for brain magnetic resonance imaging. A chest radiograph demonstrated new bilateral opacities consistent with pulmonary edema and ARDS. The patient was treated with bilevel positive airway pressure, steroids, antibiotics, and diuretics. Over the next three days, the patient clinically recovered with radiographic improvement of his lung findings. The patient was discharged home after a nearly 1-month hospitalization. Acute lung injury related to gadolinium contrast is rare, with only five previously reported cases in adults and none in children. The longer duration to onset of symptoms in our patient, along with the lack of anaphylactic symptoms, sets this case apart from previously reported cases or contrast-related ARDS and may suggest a different underlying mechanism than previously described. Pediatric intensive care providers should be aware of this potential complication in children.