Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

Figure 1 Endoscopy showing a large esophageal varix. The varix occupies more than half of the esophageal lumen. The adherent, whitish fibrin plug on top of the varix is considered a site of recent hemorrhage.

Figure 2 Non-contrast brain computed tomography showing multiple high attenuation lesions (arrows). The multiple high attenuation lesions are emboli of the Histoacryl-Lipiodol mixture. The high attenuation lesions were seen in the frontal lobe and the parieto-occipital lobe.

Figure 3 Abdominal computed tomography reveals several wedge-shaped, low attenuation lesions in the spleen, indicating infarction (arrow). A: Computed tomography (CT) before endoscopic treatment; B: CT after endoscopic treatment.

Figure 4 Transcranial Doppler bubble test showing the Doppler flow through the middle cerebral artery. The embolus is clearly represented in the power M-mode (upper panel) as a whitish sloping track. The whitish sloping track means that microemboli disrupt the ultrasonic signal (arrows).