Acute Respiratory Distress Syndrome (ARDS) After Uterine Artery Embolization
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LETTER TO THE EDITOR
Acute Respiratory Distress Syndrome (ARDS) After Uterine Artery Embolization Maja J. Wojno1,2
•
Gary Sudwarts2 • Camillo Q. H. Coccia2 • Gregory Symons1
Received: 4 June 2020 / Accepted: 10 July 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abbreviations ARDS Acute respiratory distress syndrome CRP C-reactive protein CTPA CT-pulmonary angiogram MRI Magnetic resonance imaging PVA Polyvinyl alcohol ARDS (Acute Respiratory Distress Syndrome) is a rare complication of arterial embolization, and there are only sparse reports worldwide. We describe two more cases of ARDS following uterine artery embolization (UAE) for symptomatic uterine fibroids. Both of our patients underwent fibroid embolization for massive multifibroid uteri. Since its first use in 1995, uterine artery embolization (UAE) has become a first line treatment option for uterine leiomyomas [1]. Despite large numbers of patients undergoing UFE every year, post-procedure ARDS is a rare, but serious complication of UAE. ARDS was first reported after UAE in July 2018 [2]. ARDS has also complicated Onyx embolization of a cerebral AV malformation [3] and chemoembolization of hepatocellular carcinoma in 4 patients [4], and the presumed causative factors in those cases were direct pulmonary toxicity and doxorubicin toxicity and/or lipiodol embolism, respectively. Our first patient, a 41-year-old female with no co-morbidities, underwent a UAE for a large multimyomatous uterus
& Maja J. Wojno [email protected] 1
University of Cape Town, Cape Town, South Africa
2
The Microsurgery, Suite 413, 4th Floor, The Link, Christiaan Barnard Memorial Hospital, 11 D.F Malan & Rua Bartholomeu Diaz, Foresehore, Cape Town 8001, South Africa
(volume 2638cm3) on MRI (Fig. 1). Uterine arterial haemostasis was achieved after injecting a total of eight vials of microparticles (ContourÒ PVA). The second patient, a 38-year-old female, had recurrent uterine leiomyomas and chronic iron deficiency anaemia. MRI showed a massive multifibroid uterus (volume 1468cm3). The UFE procedure was again uncomplicated, and three vials of ContourÒ PVA particles 355–500 lm were used. Both patients reported shortness of breath the day after the procedure, and the second patient also reported a mild cough. Clinical examination in both patients revealed bibasal crepitations, an increased respiratory rate and low oxygen saturations on room air. The first patient was found to have profound hypoxia on arterial blood sampling. Both patients were found to have a raised C-reactive protein (CRP). No septic focus was clinically apparent in either case. The chest radiographs showed bilateral perihilar and basal airspace opacifications. A CT Pulmonary Angiogram (CTPA) (Figs. 2 and 3) revealed diffuse ground glass opacification and small pleural effusions but no evidence of pulmonary embolism. Neither patient required intubation or mechanical ventilation. Oxygen therapy, th
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