Tödliche Lungenarterienembolie nach endoskopischer Embolisation einer »Downhill-Varize« des Ösophagus
| Autor: | R Schoel, G Rabenhorst, Michael Tsokos, W B Schwerk, A Bartel |
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| Rok vydání: | 2008 |
| Předmět: | |
| Zdroj: | DMW - Deutsche Medizinische Wochenschrift. 123:691-695 |
| ISSN: | 1439-4413 0012-0472 |
| Popis: | History and clinical findings A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism. Investigations He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix. Treatment and course The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein. Conclusion Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation. |
| Databáze: | OpenAIRE |
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