The Drug-Induced Respiratory Disease Website

Cement implantation (bone cement, kyphoplasty, vertebroplasty)

Path: Lipid/fat embolism

Specific staining may be required to separate exogenous/foreign lipids from fat and silicone (PMID 23020716)

de Froidmont S, Bonetti LR, Villaverde RV, del Mar Lesta M, Palmiere C

Postmortem findings in bone cement implantation syndrome-related deaths.

The American journal of forensic medicine and pathology 2014 Sep;35;206-11 — 2014 Sep — 206-11

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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