Acute Respiratory Distress Syndrome Following Administration of Gadolinium Contrast Agent

A Case Report

Eduardo Atsushi Osawa; Juliana Fernandez Fernandes Kleiman; Alexandre Toledo Maciel


J Med Case Reports. 2022;16(421) 

In This Article

Abstract and Introduction


Background: Gadolinium-based contrast agents are used extensively in magnetic resonance imaging to assist diagnosis of medical conditions. Despite their documented safety profile, severe adverse events do occur, and their documentation may serve to raise the awareness of the medical community.

Case Presentation: We report the case of a 15-year-old white Latin American female patient admitted to the intensive care unit for acute respiratory distress syndrome following administration of gadolinium. She did not have rash or tongue swelling but developed hypotension responsive to fluid administration and severe hypoxemia. Chest computed tomography revealed bilateral pulmonary compromise with multiple confluent consolidations. She received methylprednisolone and noninvasive ventilatory support including bilevel positive airway pressure ventilation and high-flow nasal cannula, and underwent a rapid recovery.

Conclusion: Gadolinium-based contrast agent-induced acute respiratory distress syndrome, albeit rare, should be included in the differential diagnosis of respiratory failure shortly after magnetic resonance imaging, which is nowadays a frequent diagnostic procedure, potentially increasing the awareness of this serious complication.


Gadolinium-based contrast agents (GBCAs) are employed widely in magnetic resonance imaging (MRI) to assist the diagnosis and follow-up of numerous medical conditions. It is estimated that 50 million doses are injected annually, and side effects are rarely reported.[1] Despite extensive documentation on the safety profile of GBCAs, severe adverse events occur and may serve to raise the awareness of the medical community. A rare but serious adverse event related to GBCA administration is the development of acute respiratory distress syndrome (ARDS), which is a life-threatening, extensive, and diffuse inflammatory process of the lungs with damage of the alveolocapillary barrier leading to noncardiogenic pulmonary edema, gas exchange impairment, and severe hypoxemia.[1] In this case, ARDS was the terminal complication of GBCA administration rather than the primary event. Thus, we present this case of a patient who developed ARDS after GBCA administration.