Letter to the Editor
Cyanoacrylate-related pulmonary embolism following transhepatic embolization of esophageal varices
Embolia pulmonar por cianoacrilato tras embolización transhepática de varices esofágicas
Luis Gorospe Sarasúa
, Frank Eric Farfán-Leal, Rubén Eduardo Pacios-Blanco, Raquel García-Latorre
Corresponding author
Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Despite these measures, the patient had new bleeding episodes, requiring admission to the intensive care unit, multiple transfusions and the insertion of a Sengstaken–Blakemore tube. Once stabilized, a TIPS was placed and the oesophageal varices were embolized with cyanoacrylate through the said <span class="elsevierStyleItalic">shunt</span>, sealing the left gastric vein with a “coil”. After the procedure, the patient presented with chest pain and dyspnoea. Chest radiography showed ground-glass opacities in both lungs and hyperdense linear image in the right lung. A chest CT scan was then performed without contrast to confirm the presence of embolization material in pulmonary arteries and to better characterize the pulmonary opacities. CT confirmed hyperdense material in the pulmonary arteries (related to the cyanoacrylate embolism) and bilateral areas of ground-glass attenuation (interpreted as acute lung injury related to transfusion). The patient gradually improved and was discharged from the hospital in stable condition.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cyanoacrylate-related pulmonary embolism has been described in cirrhotic patients undergoing endoscopic sclerotherapy of oesophageal and gastric varices, but there is little literature on this complication in patients with transhepatic embolization. Cyanoacrylate-related pulmonary embolism does not usually have significant clinical problems, but severe cases have been reported, particularly in patients with pulmonary arteriovenous <span class="elsevierStyleItalic">shunts</span> or patent <span class="elsevierStyleItalic">ovale</span> foramen, where there is a risk of paradoxical embolism.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> We believe that in this particular clinical setting (cirrhotic patient who underwent embolization of bleeding varices with cyanoacrylate), confirmation of hyperdense embolization material in pulmonary arteries must be determined by chest CT without contrast, and not by a chest angio-CT with intravenous contrast (in which iodinated contrast within the vessels can prevent adequate visualization of embolization material in the pulmonary arteries).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our case illustrates a very rare situation of cyanoacrylate-related pulmonary embolism secondary to a transhepatic embolization of oesophageal varices. We also believe that whenever there is clinical suspicion of this complication, a chest CT without intravenous contrast should be performed to confirm the hyperdense material inside the pulmonary arteries.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe Sarasúa L, Farfán-Leal FE, Pacios-Blanco RE, García-Latorre R. Embolia pulmonar por cianoacrilato tras embolización transhepática de varices esofágicas. Med Clin (Barc). 2016;146:e55.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary complications in chronic liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.I. Machicao" 1 => "M. Balakrishnan" 2 => "M.B. 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