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11 January 2023 : Case report  Israel

[In Press] Alveolar Hemorrhage Following Positron Emission Tomography/Computed Tomography in 2 Separate Episodes 5 Months Apart

Unknown etiology, Challenging differential diagnosis, Unexpected drug reaction

Jasmin Khateeb ORCID logo1ABDEF, Dima Shlon1EF, Samuel N. Heyman2ADF, Mogher Khamaisi13AD

DOI: 10.12659/AJCR.938668

Am J Case Rep In Press; DOI: 10.12659/AJCR.938668  

Available online: 2023-01-11, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Positron emission tomography/computed tomography (PET/CT) has become one of the most prominent modalities worldwide for the diagnosis and surveillance of malignancies. Current clinical imaging guidelines report adverse reactions following PET/CT, especially due to contrast-induced toxicities, such as contrast-induced nephropathy and other rare reactions attributed to a hypersensitivity immune response, such as bronchospasm. Other rare lung toxicities were reported in a few case reports. Herein, we report repeated episodes of alveolar hemorrhage, a novel adverse response to PET/CT, occurring on 2 separate occasions 5 months apart.
A 57 year-old female patient with breast carcinoma managed by mastectomy, adjuvant chemotherapy, irradiation, and hormonal therapy presented with massive alveolar hemorrhage following PET/CT performed for surveillance 13 years after completion of chemotherapy and irradiation. An additional episode of massive alveolar hemorrhage occurred 5 months later following PET/CT, with respiratory failure requiring mechanical ventilation. Fluorine-18 fluorodeoxyglucose ([¹⁸F] FDG) and iohexol were used for imaging on both occasions. Common causes of alveolar hemorrhage, including malignancy, were excluded.
The repeated episodes immediately following PET/CT and the earlier and more intense respiratory failure following the second event raise the possibility of an immune-mediated alveolar hemorrhage in response to either the administration of iodinated radiocontrast agent or to [¹⁸F] FDG.

Keywords: Contrast Media; Fluorodeoxyglucose F18; Hemoptysis; Positron Emission Tomography Computed Tomography; Hypersensitivity; Respiratory Insufficiency

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923