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Critical Care Research and Practice
Volume 2011 (2011), Article ID 918185, 5 pages
Case Report

Acute Respiratory Distress Syndrome after Onyx Embolization of Arteriovenous Malformation

1Department of Surgery and Department of Emergency Medicine, University of New Mexico Health Sciences Center, The University of New Mexico, MSC 10 5610, Albuquerque, NM 87131-0001, USA
2Department of Neurosurgery, University of New Mexico Health Sciences Center, The University of New Mexico, MSC 10 5615, Albuquerque, NM 87131-0001, USA

Received 5 November 2010; Accepted 4 April 2011

Academic Editor: Daniel T. Laskowitz

Copyright © 2011 Isaac Tawil et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. We report a case of a 60-year-old male who underwent sequential Onyx embolizations of a cerebral arteriovenous malformation (AVM) which we implicate as the most likely etiology of subsequent acute respiratory distress syndrome (ARDS). Methods. Case report and literature review. Results. Shortly after the second Onyx embolization procedure, the patient declined from respiratory failure secondary to pulmonary edema. Clinical entities typically responsible for pulmonary edema including cardiac failure, renal failure, iatrogenic volume overload, negative-pressure pulmonary edema, and infectious etiologies were evaluated and excluded. The patient required mechanical ventilatory support for several days, delaying operative resection. The patient met clinical and radiographic criteria for ARDS. After excluding other etiologies of ARDS, we postulate that ARDS developed as a result of Onyx administration. The Onyx copolymer is dissolved in dimethyl sulfoxide (DMSO), a solvent excreted through the lungs and has been implicated in transient pulmonary side effects. Additionally, a direct toxic effect of the Onyx copolymer is postulated. Conclusion. Onyx embolization and DMSO toxicity are implicated as the etiology of ARDS given the lack of other inciting factors and the close temporal relationship. A strong physiologic rationale provides further support. Clinicians should consider this uncommon but important complication.