title: Pulmonary emboli from therapeutic sodium hyaluronate.
abstract: A patient presented with shortness of breath and pleuritic pain shortly after bilateral knee synovial injections with sodium hyaluronate (HA). He was discharged after a brief hospitalization without a diagnosis when no Doppler or radiologic evidence of deep vein thrombosis or pulmonary  emboli was found. Radiologic studies found patchy ground glass opacities that were predominantly peripheral in disposition, with prominent septal lines in the lungs; a subsequent pulmonary function test showed a reduced diffusing capacity of the lung for carbon monoxide (D(LCO)).  These results prompted a lung biopsy that revealed multiple emboli composed of HA and fibrin in medium size pulmonary arteries, enlarged lymphatic vessels, and a bone marrow embolus. This is the first report of HA emboli following therapeutic HA injections and demonstrates that pulmonary function  tests can be used to infer the reduction in pulmonary vascular area consequent to pulmonary emboli, and so can contribute to the detection of pulmonary emboli in unusual presentations.
authors.affiliation: Division 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
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bhagat
authors.forename: Rosanna M
authors.initials: RM
authors.lastname: Forteza
authors.forename: Clay B
authors.initials: CB
authors.lastname: Calcote
authors.forename: William T
authors.initials: WT
authors.lastname: Williams
authors.forename: Steven A
authors.initials: SA
authors.lastname: Bigler
authors.forename: Terry M
authors.initials: TM
authors.lastname: Dwyer
mesh_terms: D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000139:chemically induced* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D012129:Respiratory Function Tests; D055675:Viscosupplements / Q000009:adverse effects*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid