Unmasking a rare contrast reaction: acute non-cardiogenic pulmonary oedema after iohexol injection

A woman with multiple comorbidities developed acute respiratory distress within minutes of intravenous iohexol administration for abdominal imaging. She presented with severe hypoxaemia, bilateral pulmonary crackles and diffuse opacities on chest imaging without evidence of cardiac dysfunction. Bedside echocardiography and brain natriuretic peptide levels excluded cardiogenic pulmonary oedema. A diagnosis of contrast-induced non-cardiogenic pulmonary oedema was made. She required non-invasive ventilation and supportive therapy with complete resolution over 1 week. This case highlights a rare, life-threatening but reversible reaction to iodinated contrast and underscores the importance of early recognition, prompt respiratory support and readiness with resuscitation equipment during contrast administration.