Angiotensin-Converting Enzyme Inhibitor-Induced Small-Bowel Angioedema: Clinical and Imaging Findings in 20 Patients

被引:48
作者
Scheirey, Christopher D. [1 ]
Scholz, Francis J. [1 ]
Shortsleeve, Michael J. [2 ]
Katz, Douglas S. [3 ]
机构
[1] Lahey Clin Fdn, Dept Radiol, Burlington, MA 01805 USA
[2] Mt Auburn Hosp, Dept Radiol, Cambridge, MA 02238 USA
[3] Winthrop Univ Hosp, Dept Radiol, Mineola, NY 11501 USA
关键词
angioedema; angiotensin-converting enzyme inhibitor; intestinal; small bowel; HEREDITARY ANGIONEUROTIC EDEMA; ISOLATED VISCERAL ANGIOEDEMA; ACE-INHIBITORS; GASTROINTESTINAL-TRACT; SMALL-INTESTINE; CT APPEARANCE; BLOCKADE; MDCT;
D O I
10.2214/AJR.10.4451
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
OBJECTIVE. The purpose of this article is to retrospectively review the radiologic and clinical findings in patients with angiotensin-converting enzyme inhibitor (ACEI)-induced small-bowel angioedema, with an emphasis on CT findings. MATERIALS AND METHODS. Imaging findings, with an emphasis on CT, and clinical characteristics of 20 patients (23 presentations) presenting to two institutions' emergency departments from 1996 through 2010 with ACEI-induced small-bowel angioedema were retrospectively reviewed by two abdominal radiologists who were aware of the diagnosis. Examinations were reviewed in consensus to determine common radiographic findings. RESULTS. Patient age range was 23-83 years (mean, 56 years). Sixteen of the 20 patients were women, and 15 of 20 were obese. All had acute onset of severe abdominal pain. The date of the initial episode prompting CT evaluation ranged from 2 days to 10 years after the start of ACEI therapy (average, 3.3 years). All patients underwent abdominal CT examinations while symptomatic; five patients also underwent a small-bowel series. Three patients underwent urgent surgery for presumed small-bowel ischemia. All patients had resolution of symptoms within 4 days of hospitalization. CT findings included ascites in all patients, small-bowel wall thickening (mean, 1.3 cm), mild dilatation (mean, 2.9 cm), and straightening. There was no small-bowel obstruction. CONCLUSION. ACEI-induced small-bowel angioedema should be included in the differential diagnosis when patients receiving ACEI therapy present with abdominal complaints and the following combination of findings on CT examination: ascites, small-bowel wall thickening, dilatation without obstruction, and straightening.
引用
收藏
页码:393 / 398
页数:6
相关论文
共 30 条
[1]   Lisinopril-induced isolated visceral angioedema - Review of ACE-inhibitor-induced small bowel angioedema [J].
Abdelmalek, MF ;
Douglas, DD .
DIGESTIVE DISEASES AND SCIENCES, 1997, 42 (04) :847-850
[2]   Drug-induced angioedema without urticaria - Incidence, prevention and management [J].
Agostoni, A ;
Cicardi, M .
DRUG SAFETY, 2001, 24 (08) :599-606
[3]   Hereditary and acquired angioedema: Problems and progress: Proceedings of the third C1 esterase inhibitor deficiency workshop and beyond [J].
Agostoni, Angelo ;
Aygoeren-Puersuen, Emel ;
Binkley, Karen E. ;
Blanch, Alvaro ;
Bork, Konrad ;
Bouillet, Laurence ;
Bucher, Christoph ;
Castaldo, Anthony J. ;
Cicardi, Marco ;
Davis, Alvin E., III ;
De Carolis, Caterina ;
Drouet, Christian ;
Duponchel, Christiane ;
Farkas, Henriette ;
Fay, Kalman ;
Fekete, Bela ;
Fischer, Bettina ;
Fontana, Luigi ;
Fuest, George ;
Giacomelli, Roberto ;
Groener, Albrecht ;
Hack, C. Erik ;
Harmat, George ;
Jakenfelds, John ;
Juers, Mathias ;
Kalmar, Lajos ;
Kaposi, Pal N. ;
Karadi, Istvan ;
Kitzinger, Arianna ;
Kollar, Timea ;
Kreuz, Wolfhart ;
Lakatos, Peter ;
Longhurst, Hilary J. ;
Lopez-Trascasa, Margarita ;
Martinez-Saguer, Inmaculada ;
Monnier, Nicole ;
Nagy, Istvan ;
Nemeth, Eva ;
Nielsen, Erik Waage ;
Nuijens, Jan H. ;
O'Grady, Caroline ;
Pappalardo, Emanuela ;
Penna, Vincenzo ;
Perricone, Carlo ;
Perricone, Roberto ;
Rauch, Ursula ;
Roche, Olga ;
Rusicke, Eva ;
Spaeth, Peter J. ;
Szendei, George .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2004, 114 (03) :S51-S131
[4]   CT OF THE GASTROINTESTINAL-TRACT - PRINCIPLES AND INTERPRETATION [J].
BALTHAZAR, EJ .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1991, 156 (01) :23-32
[5]   Recurrent angiotensin-converting enzyme inhibitor-associated angioedema [J].
Brown, NJ ;
Snowden, M ;
Griffin, MR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 278 (03) :232-233
[6]   Isolated visceral angioedema: An underdiagnosed complication of ACE inhibitors? [J].
Byrne, TJ ;
Douglas, DD ;
Landis, ME ;
Heppell, JP .
MAYO CLINIC PROCEEDINGS, 2000, 75 (11) :1201-1204
[7]   ACQUIRED C1 ESTERASE INHIBITOR DEFICIENCY CAUSING INTESTINAL ANGIOEDEMA - CT APPEARANCE [J].
CIACCIA, D ;
BRAZER, SR ;
BAKER, ME .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1993, 161 (06) :1215-1216
[8]   Angioedema associated with angiotensin-converting enzyme inhibitor use - Outcome after switching to a different treatment [J].
Cicardi, M ;
Zingale, LC ;
Bergamaschini, L ;
Agostoni, A .
ARCHIVES OF INTERNAL MEDICINE, 2004, 164 (08) :910-913
[9]   Original report. CT of angioedema of the small bowel. [J].
De Backer, AI ;
De Schepper, AM ;
Vendevenne, JE ;
Schoeters, P ;
Michielsen, P ;
Stevens, WJ .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2001, 176 (03) :649-652
[10]  
Dean DE, 2001, J FORENSIC SCI, V46, P1239