Pulmonary Emboli From Therapeutic Sodium Hyaluronate

Bhagat, Rajesh; Forteza, Rosanna; Calcote, Clay B.; Williams, W. T.; Bigler, Steven A.; Dwyer, Terry

doi:10.4187/respcare.01666

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…In medicine, HA is commonly used as viscosupplementation in synovial fluid for the treatment of OA, but the beneficial effects are transient and inconsistent . Although the risks of HA administration are usually minor, life‐threatening side effects have also been reported . Recent in vitro evidence links HA synthesis to the formation of EVs and there are data indicating that EVs could serve as vehicles for HA transport .…”

mentioning

confidence: 99%

First in vivo detection and characterization of hyaluronan‐coated extracellular vesicles in human synovial fluid

Mustonen

Nieminen

Joukainen

et al. 2016

Journal Orthopaedic Research

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Extracellular vesicles (EVs) function in intercellular signaling by transporting different membrane and cytosolic molecules, including hyaluronan (HA) and its synthesis machinery. As both EVs and HA are abundant in synovial fluid, we hypothesized that HA synthesized in synovial membrane would be carried on the surface of EVs. Synovial fluid (n = 15) and membrane samples (n = 5) were obtained from knee surgery patients. HA concentrations were analyzed in synovial fluid and HA and its synthesis machinery were examined with histochemical stainings in synovial membrane. To assess the size distribution of EVs in synovial fluid and to visualize HA on EVs, nanoparticle tracking analysis (NTA), confocal laser scanning microscopy (CLSM) and transmission electron microscopy (TEM) were utilized. The average HA concentration in synovial fluid was 2.0 ± 0.21 mg/ml without significant differences between the patients with trauma/diagnostic arthroscopy and primary or post-traumatic osteoarthritis. Positive stainings of HA synthases (HAS1-3), HA and its receptor CD44 in synovial cells indicated active HA secretion in synovial membrane. According to NTA, EVs were abundant in synovial fluid and their main populations were ≤300 nm in diameter after differential centrifugation. There were no significant differences in the EV counts between the patients with primary or post-traumatic osteoarthritis. TEM verified that HA-positive particles detected by CLSM were lipid membrane vesicles surrounded by a HA coat. Our results provide the first in vivo evidence that human synovial fluid contains HA-positive EVs, one source of which presumably is the long HAS-positive protrusions of synovial fibroblasts. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1960-1968, 2016.

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confidence: 99%

First in vivo detection and characterization of hyaluronan‐coated extracellular vesicles in human synovial fluid

Mustonen

Nieminen

Joukainen

et al. 2016

Journal Orthopaedic Research

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“…However, rare cases of NTPE were reported after injection of hyaluronic acid. Two cases were reported pulmonary embolism after an intra-articular injection of methylprednisolone and hyaluronate6,7. In that case, shortness of breath occurred after a knee injection of hyaluronic acid and multiple patchy ground glass opacities were observed bilaterally in the middle and lower lobes of the lungs on chest CT; biopsy revealed an amorphous material containing hyaluronic acid with fibrin.…”

Section: Discussionmentioning

confidence: 97%

“…In addition, Bhagat et al7 suggest NTPE occurs as a result of hyaluronic acid embolisms in the systemic circulation due to damage to the synovium as a result of hyaluronic acid injection. Analyzing the results of cases of various illegal silicone injections shows pulmonary silicone embolism can occur via several mechanisms such excessive local tissue pressure induced by large-dose and high-pressure injection, local massage by an unlicensed practitioner, migration effect, or direct intravascular injections9.…”

Section: Discussionmentioning

confidence: 99%

A Case of Nonthrombotic Pulmonary Embolism after Facial Injection of Hyaluronic Acid in an Illegal Cosmetic Procedure

2014

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Hyaluronic acid is widely used in medical procedures, particularly in cosmetic procedures administered by physicians or nonmedical personnel. The materials used for cosmetic procedures by physicians as well as illegally by non-medical personnel can cause nonthrombotic pulmonary embolism (NTPE). We report the case of a woman with acute respiratory failure, neurologic symptoms and petechiae after an illegal procedure of hyaluronic acid dermal filler performed by an unlicensed medical practitioner 3 days before symptom onset. Although a few cases of NTPE after injection of hyaluronic acid have been reported yet, this is the first typical case showing a NTPE manifestation after the facial injection of hyaluronic acid.

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“…HA injection has been regarded to be relatively safe as most adverse effects are local reactions including bruise, swelling, granuloma formation, and sometimes tissue necrosis or vascular occlusion (19). Pulmonary complications of HA injection were scarcely reported; only five cases had been reported so far (4,(9)(10)(11)13). As summarized in Table 1, most of the pulmonary complications are NTPEs; two cases were intra-articular injection-related and three were dermal or mucosal injection-related.…”

Section: Dah Is Characterized By the Disruption Of The Alveolar-mentioning

confidence: 99%

Hyaluronic acid-induced diffuse alveolar hemorrhage: unknown complication induced by a well-known injectable agent

Han¹,

Park²,

Lee³

2019

Ann. Transl. Med

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Hyaluronic acid (HA) is widely used in medicine, especially for contouring or volumizing soft tissue and intra-articular injection. However, it is not well known that HA injection can cause lifethreatening pulmonary complications. We recently experienced a case of a woman who was diagnosed with diffuse alveolar hemorrhage (DAH) after receiving an illegal vaginal HA filler injection. A 54-year-old female visited our clinic complaining of hemoptysis and dyspnea. Chest computed tomographic (CT) scan showed diffuse ground glass opacities and consolidation in both lower lobes. Bronchoalveolar lavage (BAL) disclosed hemorrhagic feature in sequential samples compatible with DAH. There were no relevant drugs or past medical histories, and no positive result in autoantibodies tests. During detailed history taking, she recalled that she got an illegal HA filler injection in her vaginal wall performed by nonmedical personnel the very day before the onset of symptoms. Although the procedure itself or an additive of HA preparation could be a cause, HA that might have been introduced into circulation was thought to be the most possible cause for the development of DAH. The clinical symptoms and lung lesions were dramatically improved after the treatment with systemic steroid. Pulmonary complications after HA injections were scarcely reported. Only one case of HA-related DAH has been previously described so far. Our present case emphasizes that physician and other health care providers must be aware of possible pulmonary complications of this most widely-using injectable agent.

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Pulmonary Emboli From Therapeutic Sodium Hyaluronate

Cited by 13 publications

References 8 publications

First in vivo detection and characterization of hyaluronan‐coated extracellular vesicles in human synovial fluid

First in vivo detection and characterization of hyaluronan‐coated extracellular vesicles in human synovial fluid

A Case of Nonthrombotic Pulmonary Embolism after Facial Injection of Hyaluronic Acid in an Illegal Cosmetic Procedure

Hyaluronic acid-induced diffuse alveolar hemorrhage: unknown complication induced by a well-known injectable agent

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