Ritodrine-associated Noncardiogenic Pulmonary Edema Diagnosed by Point-of-care Ultrasound: A Case Report of Twin Gestation

Ritodrine hydrochloride, a beta-adrenergic tocolytic agent, can rarely cause acute noncardiogenic pulmonary edema, particularly in patients with multiple gestations or comorbidities. We report a case of a 28-year-old woman with twin pregnancy, type 1 diabetes, and hyperthyroidism that developed acute respiratory distress following ritodrine infusion. Imaging showed pulmonary edema, and point-of-care ultrasound (POCUS) revealed diffuse bilateral B-lines, preserved left ventricular function, and no signs of right heart strain or inferior vena cava plethora. These findings supported a diagnosis of noncardiogenic pulmonary edema. Emergency cesarean section was performed at 31^+6/7 weeks. Postoperatively, the patient's respiratory status improved, and both neonates had favorable outcomes. This case demonstrates the utility of POCUS as a rapid, radiation-free diagnostic tool for differentiating types of pulmonary edema in pregnant patients, enabling timely intervention and potentially improving maternal and neonatal outcomes. It also underscores the importance of vigilant monitoring when using beta-mimetic tocolytics in high-risk pregnancies.