Laser Speckle Contrast Imaging Guides Needling Treatment of Vascular Complications from Dermal Fillers.

BACKGROUND: Although laser Doppler imaging (LDI) accurately delineates a hypoperfused area to help target hyaluronidase treatment, laser speckle contrast imaging (LSCI) is more appropriate for assessing microvascular hemodynamics and has greater reproducibility than LDI. This study investigated the use of LSCI in the evaluation and treatment of six patients who developed vascular complications after facial dermal filler injections. METHODS: The areas of vascular occlusion were accurately defined in real time by LSCI and were more precise than visual inspections or photographic evidence for guiding needling and hyaluronidase treatment. RESULTS: All patients had achieved satisfactory outcomes as early as Day 2 of treatment and no procedure-related complications were reported after a median follow-up of 9.5 (7-37) days. CONCLUSION: LSCI accurately and noninvasively delineated vascular occlusions in real time among patients experiencing complications of facial dermal filler injections. Moreover, LSCI was more accurate than visual and photographic evaluations. Clinicians can use LSCI to reliably follow-up therapeutic outcomes after salvage interventions for vascular occlusions. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A rare case of acute respiratory distress syndrome caused by use of gadolinium-based magnetic resonance imaging contrast media.

Gadolinium-based magnetic resonance imaging (MRI) contrast is generally considered to be stable and safe. Adverse reactions due to MRI contrast agents are classified into allergic-like reactions and physiological reactions. Acute respiratory distress syndrome (ARDS) caused by gadolinium-based MRI contrast is extremely rare. Due to the immediate and severe nature of ARDS, medical practitioners may seek after other aetiologies other than MRI-contrast-induced ARDS for patients' clinical manifestations such as acute-onset difficulty of breathing. It is crucial to keep in mind the possibility of ARDS after gadolinium injection, as missing the diagnosis leads to a high mortality. A clear clinical scenario of ARDS induced by gadobutrol (Gadovist, Bayer Inc., Toronto, Canada) was presented in our patient who did not develop symptoms of anaphylaxis. We successfully managed the patient with methylprednisolone and bilevel positive airway pressure ventilation and the patient was discharged in stable condition on day 6.