Journal of Thrombosis and Thrombolysis

, Volume 31, Issue 4, pp 436–444 | Cite as

Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism

  • Martina Montagnana
  • Gianfranco Cervellin
  • Massimo Franchini
  • Giuseppe Lippi


Non-thrombotic pulmonary embolism (NTPE) is commonly defined as the partial or total occlusion of the pulmonary circulation caused by a variety of non-thrombotic embolic agents. Although its prevalence is much lower than that of pulmonary thromboembolism, this life-threatening pathology is often underestimated due to the low specificity of signs and symptoms and because it might be frequently overlooked in the differential diagnosis of the chest pain. The main sources of non-thrombotic pulmonary emboli include cancers, fat, infective agents, amniotic fluid, a variety of foreign materials and gases. The diagnosis is particularly challenging. The spectrum of imaging findings using imaging techniques such as computed tomography is unpredictable and typically heterogeneous, whereas laboratory tests can only be helpful for establishing the cause but not the presence of the disease (i.e., D-dimer testing is frequently negative). As such, the clinical history along with the identification a potential underlying disease are the often the mainstay for the differential diagnosis. The aim of this article is to provide an overview of the pathophysiology, clinics and diagnostic approach to NTPE.


Non-thrombotic pulmonary embolism Venous thromboembolism Gas embolism Fat embolism Infective embolism 


  1. 1.
    Jorens PG, Van Marck E, Snoeckx A, Parizel PM (2009) Nonthrombotic pulmonary embolism. Eur Respir J 34:452–474PubMedCrossRefGoogle Scholar
  2. 2.
    King MB, Harmon KR (1994) Unusual forms of pulmonary embolism. Clin Chest Med 15:561–580PubMedGoogle Scholar
  3. 3.
    Sinicina I, Pankratz H, Bise K, Matevossian E (2010) Forensic aspects of post-mortem histological detection of amniotic fluid embolism. Int J Legal Med 124:55–62PubMedCrossRefGoogle Scholar
  4. 4.
    Nucifora G, Hysko F, Vit A, Vasciaveo A (2007) Pulmonary fat embolism: common and unusual computed tomography findings. J Comput Assist Tomogr 31:806–807PubMedCrossRefGoogle Scholar
  5. 5.
    Han D, Lee KS, Franquet T, Müller NL, Kim TS, Kim H, Kwon OJ, Byun HS (2003) Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics 23:1521–1539PubMedCrossRefGoogle Scholar
  6. 6.
    Lippi G, Cervellin G, Franchini M, Favaloro EJ (2010) Biochemical markers for the diagnosis of venous thromboembolism: the past, present and future. J Thromb Thrombolysis. doi:10.1007/s11239-010-0460-x
  7. 7.
    Huang HK, Huang CH, Wu CC, Chen WJ (2010) An unusual cause of acute pulmonary embolism. Int J Cardiol (in press)Google Scholar
  8. 8.
    Lippi G, Favaloro EJ (2008) Cardiac biomarkers in pulmonary embolism. Thromb Haemost 99:1134–1136PubMedGoogle Scholar
  9. 9.
    Jeremias A, Gibson CM (2005) Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med 142:786–791PubMedGoogle Scholar
  10. 10.
    Brill IC, Robertson TD (1937) Subacute cor pulmonale. Arch Intern Med 60:1043–1057Google Scholar
  11. 11.
    Lammi M, Wurzel J, Criner GJ (2010) Pulmonary Tumor Embolism. Lung (in press)Google Scholar
  12. 12.
    Saphir O (1947) The fate of carcinoma emboli in the lung. Am J Pathol 23:245–253PubMedGoogle Scholar
  13. 13.
    Svanes K (1971) Necrosis of tumour cells related to circulatory insufficiency in pulmonary tumour embolism. Acta Pathol Microbiol Scand A 79:553–560PubMedGoogle Scholar
  14. 14.
    Chinen K, Kazumoto T, Ohkura Y, Matsubara O, Tsuchiya E (2005) Pulmonary tumor thrombotic microangiopathy caused by a gastric carcinoma expressing vascular endothelial growth factor and tissue factor. Pathol Int 55:27–31PubMedCrossRefGoogle Scholar
  15. 15.
    Jäkel J, Ramaswamy A, Köhler U, Barth PJ (2006) Massive pulmonary tumor microembolism from a hepatocellular carcinoma. Pathol Res Pract 202:395–399PubMedCrossRefGoogle Scholar
  16. 16.
    Sakuma M, Fukui S, Nakamura M, Takahashi T, Kitamukai O, Yazu T, Yamada N, Ota M, Kobayashi T, Nakano T, Shirato K (2006) Cancer and pulmonary embolism: thrombotic embolism, tumor embolism, and tumor invasion into a large vein. Circ J 70:744–749PubMedCrossRefGoogle Scholar
  17. 17.
    Ma SQ, Lin Y, Ying HY, Shao YJ, Li XY, Bai CM (2010) Solid malignancies complicated with pulmonary embolism: clinical analysis of 120 patients. Chin Med J (Engl) 123:29–33CrossRefGoogle Scholar
  18. 18.
    Kane RD, Hawkins HK, Miller JA, Noce PS (1975) Microscopic pulmonary tumor emboli associated with dyspnea. Cancer 36:1473–1482PubMedCrossRefGoogle Scholar
  19. 19.
    Veinot JP, Ford SE, Price RG (1992) Subacute cor pulmonale due to tumor embolization. Arch Pathol Lab Med 116:131–134PubMedGoogle Scholar
  20. 20.
    Soares FA, Pinto AP, Landell GA, de Oliveira JA (1993) Pulmonary tumor embolism to arterial vessels and carcinomatous lymphangitis. A comparative clinicopathological study. Arch Pathol Lab Med 117:827–831PubMedGoogle Scholar
  21. 21.
    Winterbauer RH, Elfenbein IB, Ball WC Jr (1968) Incidence and clinical significance of tumor embolization to the lung. Am J Med 45:271–290PubMedCrossRefGoogle Scholar
  22. 22.
    Desai NR, Palomino J, Simeone F (2009) A 67-year-old woman with a remote history of breast cancer who presents with dyspnea and chest pain. Chest 136:1160–1163PubMedCrossRefGoogle Scholar
  23. 23.
    Krüger T, Mustafi M, Nadalin S, Aebert H (2010) Vena cava sarcoma with tumor embolus in the pulmonary artery: surgical treatment. Ann Thorac Surg 90:642–644PubMedCrossRefGoogle Scholar
  24. 24.
    Gabbieri D, Rossi G, Bavutti L, Corghi F, Zacà F, Sarandria D, Pierangeli A, Ghidoni I (2006) Papillary fibroelastoma of the right atrium as an unusual source of recurrent pulmonary embolism. J Cardiovasc Med (Hagerstown) 7:373–378CrossRefGoogle Scholar
  25. 25.
    Pérez Baztarrica G, Nieva N, Gariglio L, Salvaggio F, Porcile R (2010) Images in cardiovascular medicine. Primary cardiac lymphoma: a rare case of pulmonary tumor embolism. Circulation 121:2249–2250PubMedCrossRefGoogle Scholar
  26. 26.
    Skalidis EI, Parthenakis FI, Zacharis EA, Datseris GE, Vardas PE (1999) Pulmonary tumor embolism from primary cardiac B-cell lymphoma. Chest 116:1489–1490PubMedCrossRefGoogle Scholar
  27. 27.
    Blanloeil Y, Paineau J, Vissett J, Dixneuf B (1983) Intraoperative pulmonary tumor embolism after hepatectomy for liver carcinoma. Can Anaesth Soc J 30:69–71PubMedCrossRefGoogle Scholar
  28. 28.
    Matsumoto K, Nojiri J, Takase Y, Egashira Y, Azama S, Kato A, Kitahara K, Miyazaki K, Kudo S (2007) Cerebral lipiodol embolism: a complication of transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol 30:512–514PubMedCrossRefGoogle Scholar
  29. 29.
    Zhao H, Wang HQ, Fan QQ, Chen XX, Lou JY (2008) Rare pulmonary and cerebral complications after transarterial chemoembolisation for hepatocellular carcinoma: a case report. World J Gastroenterol 14:6425–6427PubMedCrossRefGoogle Scholar
  30. 30.
    Wu GC, Perng WC, Chen CW, Chian CF, Peng CK, Su WL (2009) Acute respiratory distress syndrome after transcatheter arterial chemoembolization of hepatocellular carcinomas. Am J Med Sci 338:357–360PubMedCrossRefGoogle Scholar
  31. 31.
    Yamaura K, Higashi M, Akiyoshi K, Itonaga Y, Inoue H, Takahashi S (2000) Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia. Eur J Anaesthesiol 17:704–708PubMedGoogle Scholar
  32. 32.
    Choi CS, Kim KH, Seo GS, Cho EY, Oh HJ, Choi SC, Kim TH, Kim HC, Roh BS (2008) Cerebral and pulmonary embolisms after transcatheter arterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 14:4834–4837PubMedCrossRefGoogle Scholar
  33. 33.
    Bassiri AG, Haghighi B, Doyle RL, Berry GJ, Rizk NW (1997) Pulmonary tumor embolism. Am J Resp Crit Care Med 155:2089–2095PubMedGoogle Scholar
  34. 34.
    Roberts KE, Hamele-Bena D, Saqi A, Stein CA, Cole RP (2003) Pulmonary tumor embolism: a review of the literature. Am J Med 115:228–232PubMedCrossRefGoogle Scholar
  35. 35.
    Kridel R, Myit S, Pache JC, Gaspoz JM (2008) Pulmonary tumor embolism: a rare cause of acute right heart failure with elevated D-dimers. J Thorac Oncol 3:1482–1483PubMedCrossRefGoogle Scholar
  36. 36.
    Fabian TC (1993) Unravelling the fat embolism syndrome. N Engl J Med 329:961–963PubMedCrossRefGoogle Scholar
  37. 37.
    Schnaid E, Lamprey JM, Viljoen MJ, Joffe BI, Seftel HC (1987) The early biochemical and hormonal profile of patients with long bone fractures at risk of fat embolism syndrome. J Trauma 27:309–311PubMedCrossRefGoogle Scholar
  38. 38.
    Bilgrami S, Hasson J, Tutschka PJ (1999) Case23–1998: fat embolism. N Engl J Med 340:393–397PubMedCrossRefGoogle Scholar
  39. 39.
    Godeau B, Schaeffer A, Bachir D, Fleury-Feith J, Galacteros F, Verra F (1996) Bronchoalveolar lavage in adult sickle-cell patients with acute chest syndrome: value for diagnostic assessment of fat embolism. Am J Respir Crit Care Med 153:1691–1696PubMedGoogle Scholar
  40. 40.
    Patil N, Wakankar H (2008) Morbidity and mortality of simultaneous bilateral total knee arthroplasty. Orthopedics 31:780–789PubMedCrossRefGoogle Scholar
  41. 41.
    Walker NM, Bateson T, Reavley P, Prakash D (2008) Fatal fat embolism following femoral head resection in total hip arthroplasty. Hip Int 18:332–334PubMedGoogle Scholar
  42. 42.
    Benneker LM, Heini PF, Suhm N, Gisep A (2008) The effect of pulsed jet lavage in vertebroplasty on injection forces of polymethylmethacrylate bone cement, material distribution, and potential fat embolism: a cadaver study. Spine (Phila Pa 1976) 33:E906–E910CrossRefGoogle Scholar
  43. 43.
    Guardia SN, Bilbao JM, Murray D, Warren RE, Sweet J (1989) Fat embolism in acute pancreatitis. Arch Pathol Lab Med 113:503–506PubMedGoogle Scholar
  44. 44.
    Gravante G, Araco A, Sorge R, Araco F, Nicoli F, Caruso R, Langiano N, Cervelli V (2008) Pulmonary embolism after combined abdominoplasty and flank liposuction: a correlation with the amount of fat removed. Ann Plast Surg 60:604–608PubMedCrossRefGoogle Scholar
  45. 45.
    Senen D, Atakul D, Erten G, Erdoğan B, Lortlar N (2009) Evaluation of the risk of systemic fat mobilization and fat embolus following liposuction with dry and tumescent technique: an experimental study on rats. Aesthetic Plast Surg 33:730–737PubMedCrossRefGoogle Scholar
  46. 46.
    Rayburg M, Kalinyak KA, Towbin AJ, Baker PB, Joiner CH (2010) Fatal bone marrow embolism in a child with hemoglobin SE disease. Am J Hematol 85:182–184PubMedGoogle Scholar
  47. 47.
    Richards RR (1997) Fat embolism syndrome. Can J Surg 40:334–339PubMedGoogle Scholar
  48. 48.
    Dang NC, Johnson C, Eslami-Farsani M, Haywood LJ (2005) Bone marrow embolism in sickle cell disease: a review. Am J Hematol 79:61–67PubMedCrossRefGoogle Scholar
  49. 49.
    Gladwin MT, Rodgers GP (2000) Pathogenesis and treatment of acute chest syndrome of sickle-cell anaemia. Lancet 355:1476–1478PubMedCrossRefGoogle Scholar
  50. 50.
    Oberst M, Herget G, Riede U, Kreim SY, Konrad G, Suedkamp NP, Haberstroh J (2009) Fat marrow embolism during intramedullary bone endoscopy: an experimental study in sheep. J Orthop Res 27:1060–1066PubMedCrossRefGoogle Scholar
  51. 51.
    Wenda K, Runkel M, Degreif J, Ritter G (1993) Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing—demonstrated by intraoperative echocardiography. Injury 24(Suppl 3):S73–S81PubMedCrossRefGoogle Scholar
  52. 52.
    López-Sánchez M, Alvarez-Antoñán C, Arce-Mateos FP, Gómez-Román J, Quesada-Suescun A, Zurbano-Goñi F (2010) Single lung transplantation and fatal fat embolism acquired from the donor: management and literature review. Clin Transplant 24:133–138PubMedCrossRefGoogle Scholar
  53. 53.
    Najafizadeh K, Ahmadi SH, Dezfouli AA, Mohammadi F, Kardavani B, Vishteh HR (2009) Fat and bone marrow embolization in a donor as the cause of death in a lung recipient. Transplant Proc 41:2924–2926PubMedCrossRefGoogle Scholar
  54. 54.
    Waller DA, Bennett MK, Corris PA, Dark JH (1995) Donor-acquired fat embolism causing primary organ failure after lung transplantation. Ann Thorac Surg 59:1565PubMedCrossRefGoogle Scholar
  55. 55.
    Imberti R, Scagnelli P, Amatu A (2008) Post-traumatic pulmonary and cerebral fat embolism. Anaesth Intensive Care 36:619–621PubMedGoogle Scholar
  56. 56.
    Dudney TM, Elliott CG (1994) Pulmonary embolism from amniotic fluid, fat, and air. Prog Cardiovasc Dis 36:447–474PubMedCrossRefGoogle Scholar
  57. 57.
    Metting Z, Rödiger LA, Regtien JG, van der Naalt J (2009) Delayed come in head injury: consider cerebral fat embolism. Clin Neurol Neurosurg 111:597–600PubMedCrossRefGoogle Scholar
  58. 58.
    Fred HL, Harle TS (1970) Septic pulmonary embolism. Am Fam Physician GP 1:81–87PubMedGoogle Scholar
  59. 59.
    Roberts WC, Buchbinder NA (1972) Right-sided valvular infective endocarditis: a clinicopathologic study of twelve necropsy patients. Am J Med 53:7–19PubMedCrossRefGoogle Scholar
  60. 60.
    Shiota Y, Arikita H, Horita N, Hiyama J, Ono T, Ohkawa S, Yamakido M (2002) Septic pulmonary embolism associated with periodontal disease: reports of two cases and review of the literature. Chest 121:652–654PubMedCrossRefGoogle Scholar
  61. 61.
    MacMillan JC, Milstein SH, Samson PC (1978) Clinical spectrum of septic pulmonary embolism and infarction. J Thorac Cardiovasc Surg 75:670–679PubMedGoogle Scholar
  62. 62.
    Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH (2005) Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 128:162–166PubMedCrossRefGoogle Scholar
  63. 63.
    Sözener ZC, Kayal A, Atasoy C, Kilickap M, Numanoglu N, Savas I (2008) Septic pulmonary embolism: three case reports. Monaldi Arch Chest Dis 69:75–77PubMedGoogle Scholar
  64. 64.
    Tragiannidis A, Tzouvelekis G, Eboriadou M, Fidani L, Pavlou E, Papageorgiou T, Athanassiadou F (2008) Septic pulmonary embolism due to Staphylococcus aureus. Pediatr Int 50:717PubMedCrossRefGoogle Scholar
  65. 65.
    Celikel TH, Muthuswamy PP (1984) Septic pulmonary emboli secondary to internal jugular vein phlebitis (postanginal sepsis) caused by Eikenella corrodens. Am Rev Respir Dis 130:510–513PubMedGoogle Scholar
  66. 66.
    Riordan T, Wilson M (2004) Lemierre’s syndrome: more than a historical curiosa. Postgrad Med J 80:328–334PubMedCrossRefGoogle Scholar
  67. 67.
    Kuo IC, Lu PL, Lin WR, Lin CY, Chang YW, Chen TC, Chen YH (2009) Sphingomonas paucimobilis bacteraemia and septic arthritis in a diabetic patient presenting with septic pulmonary emboli. J Med Microbiol 58:1259–1263PubMedCrossRefGoogle Scholar
  68. 68.
    Kamano Y, Ohashi H, Kikuchi T, Watanabe K, Kitahara M (2003) Liver abscess and Aeromonas bacteremia with septic pulmonary embolism. Intern Med 42:1047–1049PubMedCrossRefGoogle Scholar
  69. 69.
    Sakuma M, Sugimura K, Nakamura M, Takahashi T, Kitamukai O, Yazu T, Yamada N, Ota M, Kobayashi T, Nakano T, Shirato K (2007) Unusual pulmonary embolism: septic pulmonary embolism and amniotic fluid embolism. Circ J 71:772–775PubMedCrossRefGoogle Scholar
  70. 70.
    Murphy RA, Miller WT Jr (1996) Pulmonary mucormycosis. Semin Roentgenol 31:83–87PubMedCrossRefGoogle Scholar
  71. 71.
    Varela-Duran J, Riede UN (1980) Cardiac echinococcosis with pulmonary embolism. Pathol Res Pract 170:252–257PubMedGoogle Scholar
  72. 72.
    Lioulias A, Kotoulas C, Kokotsakis J, Konstantinou M (2001) Acute pulmonary embolism due to multiple hydatid cysts. Eur J Cardiothorac Surg 20:197–199PubMedCrossRefGoogle Scholar
  73. 73.
    Kuhlman JE, Fishman EK, Teigen C (1990) Pulmonary septic emboli: diagnosis with CT. Radiology 174:211–213PubMedGoogle Scholar
  74. 74.
    Iwasaki Y, Nagata K, Nakanishi M, Natuhara A, Harada H, Kubota Y, Yokomura I, Hashimoto S, Nakagawa M (2001) Spiral CT findings in septic pulmonary emboli. Eur J Radiol 37:190–194PubMedCrossRefGoogle Scholar
  75. 75.
    Kwon WJ, Jeong YJ, Kim KI, Lee IS, Jeon UB, Lee SH, Kim YD (2007) Computed tomographic features of pulmonary septic emboli: comparison of causative microorganisms. J Comput Assist Tomogr 31:390–394PubMedCrossRefGoogle Scholar
  76. 76.
    Meyer JR (1926) Embolia pulmonar amnio caseosa. Bras Med 2:301–303Google Scholar
  77. 77.
    Knight M, Tuffnell D, Brocklehurst P, Spark P, Kurinczuk JJ UK, System Obstetric Surveillance (2010) Incidence and risk factors for amniotic-fluid embolism. Obstet Gynecol 115:910–917PubMedCrossRefGoogle Scholar
  78. 78.
    Roberts CL, Algert CS, Knight M, Morris JM (2010) Amniotic fluid embolism in an Australian population-based cohort. BJOG (in press)Google Scholar
  79. 79.
    Kramer MS, Rouleau J, Baskett TF, Joseph KS, Maternal Health Study Group of the Canadian Perinatal Surveillance System (2006) Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet 368:1444–1448PubMedCrossRefGoogle Scholar
  80. 80.
    Abenhaim HA, Azoulay L, Kramer MS, Leduc L (2008) Incidence and risk factors of amniotic fluid embolisms: a population-based study on 3 million births in the United States. Am J Obstet Gynecol 199:49.e1–49.e8CrossRefGoogle Scholar
  81. 81.
    Clark SL, Hankins GDV, Dudley DA, Dildy GA, Porter TF (1995) Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 172:1158–1167PubMedCrossRefGoogle Scholar
  82. 82.
    Conde-Agudelo A, Romero R (2009) Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol 201:445.e1–445.e13CrossRefGoogle Scholar
  83. 83.
    Perozzi KJ, Englert NC (2004) Amniotic fluid embolism: an obstetric emergency. Crit Care Nurse 24:54–61PubMedGoogle Scholar
  84. 84.
    Mahshid N, Ahmad S, Nahid M, Afshin F (2009) Sudden cardiac arrest during cesarean section—a possible case of amniotic fluid embolism. Middle East J Anesthesiol 20:315–317PubMedGoogle Scholar
  85. 85.
    Montagnana M, Franchi M, Danese E, Gotsch F, Guidi GC (2010) Disseminated intravascular coagulation in obstetric and gynecologic disorders. Semin Thromb Hemost 36:404–418PubMedCrossRefGoogle Scholar
  86. 86.
    Benson MD (1993) Nonfatal amniotic fluid embolism. Three possible cases and a new clinical definition. Arch Fam Med 2:989–994PubMedCrossRefGoogle Scholar
  87. 87.
    Kobayashi H, Ohi H, Terao T (1993) A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2–6GalNAc. Am J Obstet Gynecol 168:848–853PubMedGoogle Scholar
  88. 88.
    Oi H, Kobayashi H, Hirashima Y, Yamazaki T, Kobayashi T, Terao T (1998) Serological and immunohistochemical diagnosis of amniotic fluid embolism. Semin Thromb Hemost 24:479–484PubMedCrossRefGoogle Scholar
  89. 89.
    Benson MD, Kobayashi H, Silver RK, Oi H, Greenberger PA, Terao T (2001) Immunologic studies in presumed amniotic fluid embolism. Obstet Gynecol 97:510–514PubMedCrossRefGoogle Scholar
  90. 90.
    Imanaka H, Takahara B, Yamaguchi H, Nakataki E, Mano A, Inui D, Oto J, Nishimura M (2010) Chest computed tomography of a patient revealing severe hypoxia due to amniotic fluid embolism: a case report. J Med Case Reports 4:55PubMedCrossRefGoogle Scholar
  91. 91.
    Sorgente A, Pedrazzini GB, Faletra FF, Moccetti T, Auricchio A (2008) Dislodgement of an Amplatzer occluder device causing iatrogenic pulmonary embolism in a patient with post-infarction ventricular septal defect. Eur Heart J 29:2698PubMedCrossRefGoogle Scholar
  92. 92.
    Surov A, Wienke A, Carter JM, Stoevesandt D, Behrmann C, Spielmann RP, Werdan K, Buerke M (2009) Intravascular embolization of venous catheter—causes, clinical signs, and management: a systematic review. J Parenter Enteral Nutr 33:677–685CrossRefGoogle Scholar
  93. 93.
    Irie W, Furukawa M, Murakami C, Kobayashi M, Maeda K, Nakamaru N, Sasaki C, Shibuya K, Nakamura S, Kurihara K (2009) A case of V-A shunt catheters migration into the pulmonary artery. Leg Med (Tokyo) 11:25–29Google Scholar
  94. 94.
    Kull E, Hernandez M, Richer JP, Borderie C, Silvain C, Beauchant M (1999) Severe pulmonary embolism after obturation of gastric varices with a butyl-cyanoacrylate and lipiodol combination. Gastroenterol Clin Biol 23:1095–1096PubMedGoogle Scholar
  95. 95.
    Wai CT, Lin M, Tan KC (2008) Hepatobiliary and pancreatic: pulmonary embolism after injection therapy for gastric varices. J Gastroenterol Hepatol 23:1306PubMedCrossRefGoogle Scholar
  96. 96.
    Prytuła A, Veereman-Wauters G, Duval EL (2008) Pulmonary embolism due to injection of Histoacryl and Lipiodol during endoscopic sclerotherapy of fundic varices. Acta Gastroenterol Belg 71:387–389PubMedGoogle Scholar
  97. 97.
    Bonardel G, Pouit B, Gontier E, Dutertre G, Mantzarides M, Goasguen O, Foehrenbach H (2007) Pulmonary cement embolism after percutaneous vertebroplasty: a rare and nonthrombotic cause of pulmonary embolism. Clin Nucl Med 32:603–606PubMedCrossRefGoogle Scholar
  98. 98.
    Famularo G, Liberati C, Sebastiani GD, Polchi S (2001) Pulmonary embolism after intra-articular injection of methylprednisolone and hyaluronate. Clin Exp Rheumatol 19:355PubMedGoogle Scholar
  99. 99.
    Park HJ, Jung KH, Kim SY, Lee JH, Jeong JY, Kim JH (2010) Hyaluronic acid pulmonary embolism: a critical consequence of an illegal cosmetic vaginal procedure. Thorax 65:360–361PubMedCrossRefGoogle Scholar
  100. 100.
    Restrepo CS, Artunduaga M, Carrillo JA, Rivera AL, Ojeda P, Martinez-Jimenez S, Manzano AC, Rossi SE (2009) Silicone pulmonary embolism: report of 10 cases and review of the literature. J Comput Assist Tomogr 33:233–237PubMedCrossRefGoogle Scholar
  101. 101.
    Khanna D, Drehmer TJ (2001) Intravenous drug abuse mimicking vasculitis. South Med J 94:505–507PubMedGoogle Scholar
  102. 102.
    Butch AJ, Yokel RA, Sigell LT, Hanenson IB, Nelson ED (1979) Abuse and pulmonary complications of injecting pentazocine and tripelennamine tablets. Clin Toxicol 14:301–306PubMedCrossRefGoogle Scholar
  103. 103.
    Fields TA (2005) Pulmonary embolization of microcrystalline cellulose in a lung transplant recipient. J Heart Lung Transplant 24:624–627PubMedCrossRefGoogle Scholar
  104. 104.
    Lippi G, Franchini M, Favaloro EJ (2009) Coagulopathies and thrombosis: usual and unusual causes and associations, part II. Semin Thromb Hemost 35:591–595PubMedCrossRefGoogle Scholar
  105. 105.
    Favaloro EJ, Lippi G, Franchini M (2010) Coagulopathies and thrombosis: usual and unusual causes and associations, part III. Semin Thromb Hemost 36:1–5PubMedCrossRefGoogle Scholar
  106. 106.
    Lippi G, Franchini M, Favaloro EJ (2009) Unsuspected triggers of venous thromboembolism—trivial or not so trivial? Semin Thromb Hemost 35:597–604PubMedCrossRefGoogle Scholar
  107. 107.
    Lunetta P, Ojanpera I, Sajantila A (2007) Fatal iatrogenic BaSO4 embolism: morphological and ultrastructural findings confirmed by X-ray microanalysis and ICP-AES. Forensic Sci Int 172:203–207PubMedCrossRefGoogle Scholar
  108. 108.
    Souders JE (2000) Pulmonary air embolism. J Clin Monit Comput 16:375–383PubMedCrossRefGoogle Scholar
  109. 109.
    Levett DZ, Millar IL (2008) Bubble trouble: a review of diving physiology and disease. Postgrad Med J 84:571–578PubMedCrossRefGoogle Scholar
  110. 110.
    Buckland RW, Manners JM (1976) Venous air embolism during neurosurgery. A comparison of various methods of detection in man. Anaesthesia 31:633–643PubMedCrossRefGoogle Scholar
  111. 111.
    Shapiro G, Green DW, Fatica NS, Boachie-Adjei O (2001) Medical complications in scoliosis surgery. Curr Opin Pediatr 13:36–41PubMedCrossRefGoogle Scholar
  112. 112.
    Losasso TJ, Black S, Muzzi DA, Michenfelder JD, Cucchiara RF (1992) Detection and hemodynamic consequences of venous air embolism. Does nitrous oxide make a difference? Anesthesiology 77:148–152PubMedCrossRefGoogle Scholar
  113. 113.
    Vartikar JV, Johnson MD, Datta S (1989) Precordial Doppler monitoring and pulse oximetry during cesarean delivery: detection of venous air embolism. Reg Anesth 14:145–148PubMedGoogle Scholar
  114. 114.
    Derouin M, Couture P, Boudreault D, Girard D, Gravel D (1996) Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy. Anesth Analg 82:119–124PubMedGoogle Scholar
  115. 115.
    Michel R (1980) Air embolism in hip surgery. Anaesthesia 35:858–862PubMedCrossRefGoogle Scholar
  116. 116.
    Leibowitz D, Benshalom N, Kaganov Y, Rott D, Hurwitz A, Hamani Y (2010) The incidence and haemodynamic significance of gas emboli during operative hysteroscopy: a prospective echocardiographic study. Eur J Echocardiogr 11:429–431PubMedCrossRefGoogle Scholar
  117. 117.
    Stoloff DR, Isenberg RA, Brill AI (2001) Venous air and gas emboli in operative hysteroscopy. J Am Assoc Gynecol Laparosc 8:181–192PubMedCrossRefGoogle Scholar
  118. 118.
    Vesely TM (2001) Air embolism during insertion of central venous catheters. J Vasc Interv Radiol 12:1291–1295PubMedCrossRefGoogle Scholar
  119. 119.
    Lorusso R, Gelsomino S, De Cicco G (2008) Acute pulmonary embolism after removal of central venous catheter. Int J Cardiol 129:e64–e65PubMedCrossRefGoogle Scholar
  120. 120.
    Athar MK, Islam T, Grammes J, Athar MN (2005) Near-fatal pulmonary air embolus from iatrogenic injection of air during contrast administration. QJM 98:231–232PubMedCrossRefGoogle Scholar
  121. 121.
    Hirata N, Kanaya N, Yamazaki Y, Sonoda H, Namiki A (2010) Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting. J Anesth 24:114–116PubMedCrossRefGoogle Scholar
  122. 122.
    Khalil KF, Saeed W (2010) Pulmonary embolism in soldiers serving at high altitude. J Coll Physicians Surg Pak 20:468–471PubMedGoogle Scholar
  123. 123.
    Linér MH, Andersson JP (2010) Suspected arterial gas embolism after glossopharyngeal insufflation in a breath-hold diver. Aviat Space Environ Med 81:74–76PubMedCrossRefGoogle Scholar
  124. 124.
    Bull JL (2005) Cardiovascular bubble dynamics. Crit Rev Biomed Eng 33:299–346PubMedCrossRefGoogle Scholar
  125. 125.
    Barak M, Katz Y (2005) Microbubbles: pathophysiology and clinical implications. Chest 128:2918–2932PubMedCrossRefGoogle Scholar
  126. 126.
    Flick MR, Perel A, Staub NC (1981) Leukocytes are required for increased lung microvascular permeability after microembolization in sheep. Circ Res 48:344–351PubMedGoogle Scholar
  127. 127.
    Lachmann B, Eijking EP, So KL, Gommers D (1994) In vivo evaluation of the inhibitory capacity of human plasma on exogenous surfactant function. Intensive Care Med 20:6–11PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Martina Montagnana
    • 1
  • Gianfranco Cervellin
    • 2
  • Massimo Franchini
    • 3
  • Giuseppe Lippi
    • 4
    • 5
  1. 1.Sezione di Chimica Clinica, Dipartimento di Scienze della Vita e della RiproduzioneUniversità di VeronaVeronaItaly
  2. 2.U.O. di Pronto Soccorso e Medicina d’ UrgenzaAzienda Ospedaliero-Universitaria di ParmaParmaItaly
  3. 3.Servizio di Immunoematologia e Trasfusione – Azienda Ospedaliero-Universitaria di ParmaParmaItaly
  4. 4.U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di LaboratorioAzienda Ospedaliero-Universitaria di ParmaParmaItaly
  5. 5.Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-BiomedicheOspedale Policlinico G.B. RossiVeronaItaly

Personalised recommendations