Accidental iohexol bronchography

A 43-year-old woman underwent a video fluoroscopic swallowing study as a part of evaluation for dysphagia during which 10 mL of iohexol (Omnipaque) was given as a contrast medium. As the patient aspirated some of the contrast medium, the procedure was abandoned immediately. She maintained an arterial oxygen saturation of 95% in room air. Chest radiographs showed tracking of the contrast along the bronchi of both lower lobes showing a classical ‘bronchography’ (figure 1A). The patient was treated with intravenous piperacillin+tazobactam and clindamycin for aspiration pneumonia and chest physiotherapy. She was discharged after 7 days with no symptoms. At follow-up 2 weeks later, she was doing well with a repeat chest radiograph showing clearance of the radiocontrast deposits (figure 1B) and contrast-enhanced CT imaging of the lungs revealing residual contrast deposition in the distal bronchi of both lower lobes (figure 1C).