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Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy

Iodinated contrast media can rarely cause severe allergic reactions during nonvascular urologic imaging procedures. Alternatives like gadolinium-based contrast may help mitigate this risk in susceptible patients. A 66-year-old woman with a documented iodine allergy presented with an obstructing ston...

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Autores principales: Khan, Firaas A, Balbona, Joseph, Hernandez, David J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659587/
https://www.ncbi.nlm.nih.gov/pubmed/38021763
http://dx.doi.org/10.7759/cureus.47439
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author Khan, Firaas A
Balbona, Joseph
Hernandez, David J
author_facet Khan, Firaas A
Balbona, Joseph
Hernandez, David J
author_sort Khan, Firaas A
collection PubMed
description Iodinated contrast media can rarely cause severe allergic reactions during nonvascular urologic imaging procedures. Alternatives like gadolinium-based contrast may help mitigate this risk in susceptible patients. A 66-year-old woman with a documented iodine allergy presented with an obstructing stone in the right ureter. To avoid the risk of an allergic reaction, the decision was made to use an alternative non-iodinated contrast agent for retrograde pyelography prior to ureteral stent placement. Gadobenate dimeglumine, an MRI contrast agent, was diluted 50:50 with saline and utilized successfully to provide adequate opacification for safe stent placement without adverse reaction. The patient underwent repeat pyelography with gadobenate dimeglumine one month later during ureteroscopy without complication. This case demonstrates that diluted gadobenate can serve as an effective alternative to iodinated contrast media in patients at high risk of reaction to iodine-containing agents. While severe reactions to iodinated contrast are uncommon in nonvascular urologic procedures, they can still occur even with premedication. Gadolinium-based agents have been reported to provide sufficient opacification for most urologic interventions, though inferior radiographically to iodinated contrast. Further study on gadolinium efficacy and safety in this setting is warranted. However the present case supports gadobenate dimeglumine as a viable option for retrograde pyelography when allergy risk precludes iodinated contrast use. 
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spelling pubmed-106595872023-10-21 Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy Khan, Firaas A Balbona, Joseph Hernandez, David J Cureus Radiology Iodinated contrast media can rarely cause severe allergic reactions during nonvascular urologic imaging procedures. Alternatives like gadolinium-based contrast may help mitigate this risk in susceptible patients. A 66-year-old woman with a documented iodine allergy presented with an obstructing stone in the right ureter. To avoid the risk of an allergic reaction, the decision was made to use an alternative non-iodinated contrast agent for retrograde pyelography prior to ureteral stent placement. Gadobenate dimeglumine, an MRI contrast agent, was diluted 50:50 with saline and utilized successfully to provide adequate opacification for safe stent placement without adverse reaction. The patient underwent repeat pyelography with gadobenate dimeglumine one month later during ureteroscopy without complication. This case demonstrates that diluted gadobenate can serve as an effective alternative to iodinated contrast media in patients at high risk of reaction to iodine-containing agents. While severe reactions to iodinated contrast are uncommon in nonvascular urologic procedures, they can still occur even with premedication. Gadolinium-based agents have been reported to provide sufficient opacification for most urologic interventions, though inferior radiographically to iodinated contrast. Further study on gadolinium efficacy and safety in this setting is warranted. However the present case supports gadobenate dimeglumine as a viable option for retrograde pyelography when allergy risk precludes iodinated contrast use.  Cureus 2023-10-21 /pmc/articles/PMC10659587/ /pubmed/38021763 http://dx.doi.org/10.7759/cureus.47439 Text en Copyright © 2023, Khan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiology
Khan, Firaas A
Balbona, Joseph
Hernandez, David J
Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy
title Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy
title_full Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy
title_fullStr Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy
title_full_unstemmed Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy
title_short Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy
title_sort exploring gadolinium-based contrast media for retrograde pyelography in the context of iodine allergy
topic Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10659587/
https://www.ncbi.nlm.nih.gov/pubmed/38021763
http://dx.doi.org/10.7759/cureus.47439
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