A SEVERE REACTION TO ANGIO-CONRAY.

Abstract

Since January 1961, when the first report of the clinical use of Angio-Conray (sodium iothalamate 80 per cent) appeared, numerous articles have indicated this is the contrast medium of choice for aortography (1–6). Its physical and chemical properties have been described (1), and its low viscosity and relatively low toxicity represent a distinct advance in the field of radiographic contrast media. Complications were first recorded in 1961 by Dotter et al. (7) who encountered 2 in the course of 260 injections. Dotter's preliminary report suggested, however, that if further clinical experience confirmed initial impressions of relative safety and freedom from side-effects, Angio-Conray would warrant the term “drug of choice,” at least until a better preparation were found. Steinberg, who injected Angio-Conray intravenously in a series of over 400 patients, reported severe reactions in 6, all of whom recovered. The reactions were described as pallor, bradycardia, hypotension, apnea, and cardiac arrest. Bernstein et al. (8) performed clinical angiography in 44 patients; in 5 cardiac complications, including ventricular fibrillation, ensued. Several authors have found Angio-Conray the least toxic angiographic contrast medium yet tested, less toxic than any other available concentrated contrast medium, and therefore the agent of choice for intravascular injections (2). To the author's knowledge, there have been no reports of serious reactions during aortography, attributed to Angio-Conray. It is the purpose of this communication to emphasize that the search for an ideal compound, i.e., one entirely nontoxic that can be injected in smaller quantities than those now available, must continue as suggested by Steinberg. A case is presented in which immediate pharmacologic reaction occurred due to the injection of Angio-Conray, with deterioration directly following its administration, resulting in circulatory insufficiency unresponsive to treatment. This must be regarded as a complication of the injection, as recently suggested by Amundsen (9). Case Report A 58-year-old white male janitor was admitted to York Hospital for the first time on Jan. 1, 1963, with a chief complaint of shortness of breath of two years duration. During the two months prior to admission, the dyspnea increased markedly. The patient was unable to lie down and had a chronic nonproductive cough. A typical case of rheumatic fever at the age of sixteen with carditis and arthritis was reported, with a subsequent exacerbation at the age of twenty. Physical examination: Vital signs were normal. Minimal cyanosis of the nail beds and clubbing of the fingers were noted. Expansion of the thorax was limited and there was an increased thoracic diameter on the anteroposterior projection. The lungs were hyper-resonant, and the patient was unable to blow out a match four inches from his lips. Examination of the heart revealed generalized cardiomegaly.