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Bowel Angioedema Associated With Iodinated Contrast Media: Incidence and Predisposing Factors

Seo, Nieun MD, PhD*; Chung, Yong Eun MD, PhD*; Lim, Joon Seok PhD*; Song, Mi Kyung PhD; Kim, Myeong-Jin MD, PhD*; Kim, Ki Whang MD, PhD*

doi: 10.1097/RLI.0000000000000371
Original Articles

Objective Bowel angioedema is an acute adverse reaction to iodinated contrast media (CM) that involves the gastrointestinal tract. We aimed to investigate the incidence and predisposing factors of iodinated CM-associated bowel angioedema during computed tomography (CT) examinations.

Materials and Methods This study was approved by our institutional review board, and informed consent was waived due to its retrospective design. From July 2013 to July 2015, adult patients with a history of adverse reactions to iodinated CM during CT (group A, n = 427) and patients without adverse reactions matched for age and sex with the propensity-score matching method (group B, n = 427) were studied. Contrast media–associated bowel angioedema was determined when bowel wall thickness increased after contrast enhancement compared with the precontrast scan. Potential predisposing factors including patient demographics, symptoms and time of adverse reactions, and CM-related factors were compared between patients with and without angioedema in group A. In addition, the incidence of bowel angioedema was compared between groups A and B.

Results The incidence of CM-associated bowel angioedema in group A was 3.3% (14/427) in the per-patient analysis and 2.6% (15/578) in the per-examination analysis. The CM–associated bowel angioedema involved the distal duodenum and/or proximal jejunum and showed long-segmental circumferential bowel wall thickening on CT. None of the studied predisposing factors was different between patients with and without bowel angioedema (P > 0.05). The incidence of CM-associated bowel angioedema in group B was 1.9% (8/427) and 1.7% (8/458) for per-patient and per-examination analyses, respectively, and these rates were not significantly different between groups A and B (P = 0.346 and P = 0.370, respectively).

Conclusions The incidence of CM-associated bowel angioedema during CT was 1.7% to 3.3%, and none of the studied predisposing factors was associated with bowel angioedema.

From the *Department of Radiology, Severance Hospital, and †Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea.

Received for publication December 11, 2016; and accepted for publication, after revision, March 1, 2017.

Conflicts of interest and sources of funding: This research was supported in part by a grant from the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A1A2057091).

The authors report no conflicts of interest.

Correspondence to: Yong Eun Chung, MD, PhD, Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea. E-mail:

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