N-butyl-2-cyanoacrylate pulmonary embolism and left adrenal venous infarction

Discussion:

Transendoscopic (endoscopic ultrasound-guided) injection of glue ( N-butyl-2-cyanoacrylate) into bleeding gastric varices is a well recognized treatment.

There is always a risk of glue leak into draining veins. This is usually into the portal venous system via the left gastric vein but there are also gastro-renal (porto-systemic) venous collaterals that enlarge due to the underlying portal hypertension allowing spill of glue into the systemic venous circulation (thus entering pulmonary artery branches via the right heart).

In this case it also appears that a collateral left adrenal vein has been occluded by the glue as the left adrenal is swollen with surrounding inflammation suggestive of venous infarction.

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