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Pulmonary emboli from therapeutic sodium hyaluronate
Rajesh Bhagat1, Rosanna M Forteza, Clay B Calcote
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, GV Sonny Montgomery Veterans Affairs Medical Center, and University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA. tdwyer@umc.edu
Respiratory Care
|March 16, 2012
Summary
Sodium hyaluronate (HA) injections can cause pulmonary emboli, leading to breathing difficulties. Pulmonary function tests can help detect these unusual emboli when other methods fail.
Area of Science:
- Pulmonary Medicine
- Rheumatology
- Pathology
Background:
- Hyaluronate (HA) is commonly used for osteoarthritis treatment.
- Adverse events following HA injections are typically localized.
Observation:
- A patient developed shortness of breath and pleuritic pain post-bilateral knee HA injections.
- Initial investigations for deep vein thrombosis and pulmonary embolism were negative.
- Radiological findings included peripheral ground glass opacities and septal lines.
Findings:
- Lung biopsy revealed hyaluronate (HA) and fibrin emboli in pulmonary arteries and lymphatic vessels.
- A bone marrow embolus was also identified.
- Pulmonary function tests showed reduced diffusing capacity of the lung for carbon monoxide (D(LCO)).
Implications:
- This is the first report of pulmonary emboli caused by therapeutic hyaluronate (HA) injections.
- Pulmonary function tests can aid in diagnosing pulmonary emboli in atypical cases.
- Highlights the importance of considering non-thrombotic causes for pulmonary symptoms post-HA injection.
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