Navigating Complex Pulmonary Emergencies in Modern Therapeutics

Emergency physicians must now contend with pulmonary emergencies triggered not only by classic thromboembolic disease but also by unintended consequences of targeted therapies and interventional procedures, where early misattribution can delay life-saving measures.

Within crowded emergency departments, sudden hypoxemia following infusion of B-cell–depleting agents may mimic infection or disease progression. A case report on rituximab-induced lung injury revealed immune dysregulation precipitating interstitial pneumonitis, highlighting the importance of considering rituximab-induced lung injury in differential diagnoses.

Concurrently, advances in interventional radiology have introduced unique embolic hazards: during pelvic variceal embolization, inadvertent migration of cyanoacrylate glue can lodge within pulmonary arteries and trigger acute right ventricular strain, as documented in a case report on pulmonary glue embolism.

A potential mechanism in rituximab-induced lung injury involves complement activation and cytokine-driven alveolar inflammation, suggesting that prompt recognition of subtle ground-glass opacities or interstitial patterns may arrest progression to respiratory failure.

Key diagnostic clues arise from a spectrum of respiratory symptoms—new-onset cough, progressive dyspnea and unexplained hypoxemia—accompanied by radiological variability from patchy consolidations to diffuse opacities, as detailed in a recent study on drug-induced lung injury.

Management of rituximab-induced lung injury involves discontinuation of the drug and the initiation of corticosteroid therapy, as recommended by a systematic review. In contrast, embolic complications require anticoagulation with direct oral agents, guided by validated risk stratification and supported by multidisciplinary Pulmonary Embolism Response Teams, according to research on PERT.

Distinguishing therapy-induced lung injury and glue embolism from primary pulmonary pathology demands meticulous procedural and medication histories, early high-resolution imaging and seamless collaboration between emergency, hematology and interventional teams; ongoing work on predictive biomarkers and streamlined protocols promises to sharpen prevention and accelerate intervention for these emerging complications.

Key Takeaways:

• Integration of Rituximab in treatment regimens can lead to acute lung injury; understanding immune mechanisms is crucial for early detection.
• Glue embolism remains a rare but significant risk post-radiological procedures; vigilance and precise technique are essential to mitigate procedural hazards.
• Rapid recognition of drug-induced lung disease hinges on correlating clinical presentation with imaging patterns to ensure timely management in emergency settings.