title: [Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix].
abstract: METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institut für Rechtsmedizin, Universität Hamburg.
authors.forename: M
authors.initials: M
authors.lastname: Tsokos
authors.forename: A
authors.initials: A
authors.lastname: Bartel
authors.forename: R
authors.initials: R
authors.lastname: Schoel
authors.forename: G
authors.initials: G
authors.lastname: Rabenhorst
authors.forename: W B
authors.initials: WB
authors.lastname: Schwerk
mesh_terms: D000368:Aged; D001344:Autopsy; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004659:Enbucrilate / Q000008:administration & dosage; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005547:Foreign Bodies / Q000150:complications* / Q000209:etiology / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011655:Pulmonary Embolism / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012597:Sclerosing Solutions / Q000008:administration & dosage
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004659:Enbucrilate
vernacular_title: Tödliche Lungenarterienembolie nach endoskopischer Embolisation einer "Downhill-Varize" des Osophagus.