電腦斷層含碘顯影劑引發嚴重不良反應－案例報告Kounis症候群

Severe Adverse Reactions to Iodinated Contrast Media for CT-Case Report; Kounis Syndrome

10.6717/JTMRT.202407_12(1).0004

李基訓(Chi-Hsun Lee)；李婕寧(Jie-Ning Lee)；王心妤(Hsin-Yu Wang)；蔡子禾(Tzu-Ho Tsai)；陳名聖(Ming-Sheng Chern)

含碘顯影（對比）劑 ； 冠狀動脈電腦斷層檢查 ； 急性冠心症 ； Kounis症候群 ； Iodinated contrast media ； coronary CTA ； acute coronary syndrome(ACS) ； Kounis syndrome

臺灣醫事放射期刊

12卷1期（2024 / 07 / 01）

36 - 41

繁體中文;英文

Kounis症候群是因為過敏所引發的冠狀動脈攣縮、心肌梗塞或支架栓塞等症狀。由於做電腦斷層（CT）檢查時，常需施打含碘顯影（對比）劑，但即使用非離子性（non-ionic）含碘顯影劑做檢查，還是有產生藥物不良反應的風險，常見的不良反應以類過敏反應為主，症狀包含局部蕁麻疹、皮膚紅腫、鼻塞、打噴嚏、流鼻水及結膜炎等等，此處報導一例冠狀動脈電腦斷層檢查（coronary CTA，CCTA）時，因施打顯影劑後產生即發性嚴重不良反應，根據住院期間相關檢查報告，包含CCTA診斷右冠狀動脈中度狹窄，心電圖報告顯示急性冠心症（Acute coronary syndrome, ACS），且抽血心肌酵素Trop-I升高，經心臟科綜合判斷，此案例為極少見的嚴重不良反應Kounis症候群第二型；未來如接觸有這類反應受檢者，應建議避免含碘顯影劑相關檢查。對放射診斷科而言受檢者安全是非常重要的，因此我們整理相關資料與大家分享。

Kounis syndrome is a symptom of coronary artery spasm, myocardial infarction, or stent embolism caused by allergies. When doing computed tomography (CT) examinations, it is often necessary to use iodinated contrast media, but even if non-ionic iodine-containing agents are used for examinations, there is still a risk of adverse drug reactions. Common adverse reactions are mainly allergic reactions, with symptoms including local urticaria, skin redness and swelling, nasal congestion, sneezing, runny nose, conjunctivitis, etc. Herein, we encountered a case of an immediate severe adverse reaction after the administration of contrast agent during coronary computed tomographic angiography (coronary CTA, CCTA). According to the relevant examination reports during hospitalization, CCTA diagnosed moderate stenosis of the right coronary artery, the electrocardiogram report showed acute coronary syndrome (ACS), and the blood myocardial enzyme Trop-I was elevated. After comprehensive judgment by the cardiology department, this case It is a very rare serious adverse reaction called Kounis syndrome type 2; if you come into contact with subjects who have such reactions in the future, they should be advised to avoid examinations related to iodine-containing contrast agents. The safety of subjects is very important to the diagnostic radiology department, so we have compiled relevant information to share with others who are interested in this field.