A 31-year-old woman developed nonthrombotic and thrombotic pulmonary embolism after undergoing radiological embolization for pelvic varices using 20 mL n-butyl-2-cyanoacrylate glue following placement of security coils, a recent case report showed. She presented with pelvic pain, dyspareunia, and metrorrhagia. Imaging revealed voluminous pelvic varices, which prompted embolization of both ovarian veins.

Glue migration into distal pulmonary arteries was observed during the intervention, and a chest CT performed immediately afterward showed multiple bilateral hyperdense elements in the pulmonary vasculature, though the patient was asymptomatic. Respiratory symptoms—including shortness of breath, chest pain, and hypoxemia—emerged 24 hours postprocedure and worsened over several days. CT angiography confirmed glue migration to the lungs and a thrombotic embolism in the left lower lobe.

“Pulmonary glue embolism should be suspected when patients develop respiratory symptoms following radiologic embolization,” wrote Elise Longueville of the Department of Respiratory Medicine at the University Hospital of Reims in France, with colleagues in their report.

The patient required anticoagulation, oxygen therapy, corticosteroids, and antibiotics. While her condition improved, mild dyspnea persisted for several months. Three days after the procedure, respiratory symptoms worsened and the patient required 3 L/min of oxygen. CT showed pulmonary infiltrates with ground-glass opacities, septal thickening, and consolidation. Oxygen support was increased to 6 L/min. Treatment included tinzaparin 175UI/kg, amoxicillin/clavulanic acid 3 g daily, and oral corticosteroids at 1 mg/kg for 10 days.

Echocardiography showed systolic pulmonary artery pressure (sPAP) of 39 mm Hg without right heart failure. The patient improved clinically and was discharged after 10 days with 2 L/min of home oxygen and continued anticoagulation.

At 3 months, oxygen therapy was discontinued. Pulmonary function tests were normal:

• FEV₁ = 2.76 L (103% of predicted value)

• FVC = 4.04 L (130% of predicted value)

• DLCO = 94%

A ventilation-perfusion scan showed bilateral subsegmental mismatches that affected 5% to 10% of lung parenchyma. The 6-minute walk test—499 m with a minimum SpO₂ of 99%—was normal with no desaturation. Echocardiography showed normalized sPAP of 25 mm Hg. At 9 months, only mild dyspnea persisted (mMRC Grade 1).

This was a single case report, and findings are not generalizable. No standardized clinical guidelines exist for managing nonthrombotic pulmonary embolism following pelvic vein embolization, though the literature includes practical guidance including patient education before the procedure and levels of recommended physical activity immediately after the procedure and in the days that follow..

Glue migration is a rare but possible complication of pelvic embolization procedures. Large volumes of glue, such as the 20 mL used in this case, may increase the risk of pulmonary embolism. The authors concluded that clinical monitoring is recommended for any patient who develops respiratory symptoms following glue-based interventions.

The authors reported no conflicts of interest.

Source: BMC Pulmonary Medicine