Symmetrical Neck Swelling After Percutaneous Coronary Intervention

Abstract

Cervical edema after iodinated contrast media administration can raise the suspicion of a hypersensitivity reaction, but other diagnoses must be considered. The authors present a rare case of a man who, during the diagnostic investigation of a patient with thoracic pain developed severe submandibular swelling and local pain after a percutaneous coronary intervention with iodinated contrast media. The cervical computerized tomography revealed enlargement of the submandibular glands with adjacent fat stranding, suggesting contrast-induced sialadenitis. In the allergology department skin prick tests, intradermal tests and epicutaneous test with suspected iodinated contrast media and alternative were performed, which were negative. Drug provocation tests with alternative iodinated contrast media were negative. Different approaches can be considered when approaching these patients. Our algorithm includes the evaluation of a potential hypersensitivity reaction with a skin test and drug provocation test with alternative iodinated contrast media.