Pulmonary Glue Embolism: An unusual complication following endoscopic sclerotherapy for gastric varices.

A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butyl-cyanoacrylate and lipiodol). This condition may be associated with a delayed onset of respiratory compromise. Therefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infirmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. The aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.

Dual-energy computed tomographic tendon algorithm in acute trauma: initial experiences.

Computed tomography has become increasingly popular in the assessment of limbs in the acute trauma setting. Bony anatomic detail is excellent; however, soft tissue detail is typically limited, especially when compared with ultrasound and magnetic resonance imaging. The advent of dual-energy computed tomography has allowed additional information to be gathered regarding the morphology of collagen-based soft tissue structures. We report our initial experiences of 4 cases with imaging and clinical correlation.