RT Journal Article
SR Electronic
T1 Pulmonary Emboli From Therapeutic Sodium Hyaluronate
JF Respiratory Care
FD American Association for Respiratory Care
SP 1670
OP 1673
DO 10.4187/respcare.01666
VO 57
IS 10
A1 Rajesh Bhagat
A1 Rosanna M Forteza
A1 Clay B Calcote
A1 William T Williams
A1 Steven A Bigler
A1 Terry M Dwyer
YR 2012
UL http://rc.rcjournal.com/content/57/10/1670.abstract
AB A patient presented with shortness of breath and pleuritic pain shortly after bilateral knee synovial injections with sodium hyaluronate (HA). He was discharged after a brief hospitalization without a diagnosis when no Doppler or radiologic evidence of deep vein thrombosis or pulmonary emboli was found. Radiologic studies found patchy ground glass opacities that were predominantly peripheral in disposition, with prominent septal lines in the lungs; a subsequent pulmonary function test showed a reduced diffusing capacity of the lung for carbon monoxide (DLCO). These results prompted a lung biopsy that revealed multiple emboli composed of HA and fibrin in medium size pulmonary arteries, enlarged lymphatic vessels, and a bone marrow embolus. This is the first report of HA emboli following therapeutic HA injections and demonstrates that pulmonary function tests can be used to infer the reduction in pulmonary vascular area consequent to pulmonary emboli, and so can contribute to the detection of pulmonary emboli in unusual presentations.