Type I Anaphylactic Reaction Due to Contrast Induced Angioedema Causing Neck Swelling: Role of Sitting Fiberoptic Bronchoscopy in Emergent Intubation

Contrast induced angioedema is a rapidly progressive state involving a number of organ systems, including the upper airway tract; which is usually a type I anaphylactic reaction also known as immediate hypersensitivity reaction. Prompt preservation of the respiratory tract is the cornerstone of this situation. The use of fiberoptic bronchoscope for tracheal intubation though very helpful, has some special considerations due to the anatomic distortions created by edema. This manuscript describes a patient with contrast induced angioedema managed successfully. Serum levels of immunoglobulin E were highly increased during the first hours after the event; while serum levels of complement were normal. However, rapid airway management and prophylactic intubation saved the patient and prevented the possible aftermath of airway obstruction.