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Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient. CEN Case Rep 2020; 9:308-312. [PMID: 32323214 PMCID: PMC7502096 DOI: 10.1007/s13730-020-00456-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/11/2020] [Indexed: 12/05/2022] Open
Abstract
Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.
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Massive systemic arterial air embolism caused by an air shunt after blunt chest trauma: A case report. Int J Surg Case Rep 2018; 51:368-371. [PMID: 30268062 PMCID: PMC6170213 DOI: 10.1016/j.ijscr.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/31/2018] [Accepted: 09/08/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Systemic arterial air embolism (SAAE) is a rare but fatal condition, with only a few cases reported, and the detailed etiology underlying SAAE remains unknown. We report a first case of massive SAAE after blunt chest injury, wherein the presence of traumatic air shunt was confirmed by direct observation during surgery. We also summarize our experience with six other SAAE cases. PRESENTATION OF CASE A 68-year-old woman was admitted in a state of cardiac arrest after a fall. Emergency room thoracotomy determined complete transection of left main bronchus and left superior pulmonary vein. Postmortem computed tomography (CT) revealed full of air in the aortic arch, the descending aorta, and the great vessels. Therefore, one of the cause of death might be SAAE. DISCUSSION An air shunt after blunt chest trauma can cause SAAE, and clinical signs and operative findings can provide clues for possible SAAE. The bronchopulmonary vein fistula, the aortic injury and full-thickness myocardial injury have the potential to become traumatic air shunts. In cases with a coexisting air shunt, pneumothorax, lung contusions and positive-pressure ventilation can be risk factors for SAAE, as sources of air continually entering the systemic arterial circulation. CONCLUSION SAAE is caused by an air shunt following trauma. Clinical signs and operative findings summarized in this case should aid in the recognition of possible SAAE.
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Abstract
Exposure to the underwater environment is associated with several unique disorders that may require recompression in a hyperbaric chamber. Increasing pressure during descent reduces the volume of the paranasal sinuses and middle ear, which, if not properly equalized, will sustain injury due to barotrauma. Barotrauma of the inner ear results in vertigo, tinnitus, and often permanent hearing loss. During ascent, expanding gas can produce lung injury accompanied by pneumothorax, mediastinal and subcutaneous emphysema, injection of air into the pulmonary veins, and arterial air embolism to the brain. Divers with pulmonary barotrauma often present with unconsciousness, seizures, or other evidence of cerebral dysfunction. Rapid treatment with recompression often reverses the cerebral deficits. Air embolism lesions are usually diffuse, in contradistinction to a stroke which usually follows the distribution of a single cerebral artery. Decompression sickness is a disorder caused by evolution of supersaturated dissolved gas in tissues and blood following exposure to increased pressure. Protocols for avoiding excess supersaturation during ascent from depth have been available for more than 100 years, and diving is considered safe when established decompression schedules are followed. Decompression sickness causes pain in the joints of the upper and lower extremities, and can injure the spinal cord. Paralysis, paresthesias, sensory loss, and bowel and bladder paralysis accompany spinal cord injury. Treatment involves recompression and oxygen. Platelet inhibitors and other anti-inflammatory drugs are also useful. A diving disorder must be considered in any patient with a neurologic syndrome, vertigo, hearing loss, or joint pain following diving.
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Affiliation(s)
- Alfred A. Bove
- Section of Cardiology, Temple University Medical School, Philadelphia, PA,
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Ishida M, Gonoi W, Okuma H, Shirota G, Shintani Y, Abe H, Takazawa Y, Fukayama M, Ohtomo K. Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions. Korean J Radiol 2015; 16:798-809. [PMID: 26175579 PMCID: PMC4499544 DOI: 10.3348/kjr.2015.16.4.798] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
Abstract
Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions.
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Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Radiology, Mutual Aid Association for Tokyo Metropolitan Teachers and Officials, Sanraku Hospital, Tokyo 101-8326, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hidemi Okuma
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yukako Shintani
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yutaka Takazawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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5
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Brook OR, Hirshenbaum A, Talor E, Engel A. Arterial air emboli on computed tomography (CT) autopsy. Injury 2012; 43:1556-61. [PMID: 21145060 DOI: 10.1016/j.injury.2010.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/25/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe radiological appearances of systemic air emboli versus intravascular air from putrefaction. MATERIALS AND METHODS The hospital trauma database was searched for patients who underwent computed tomography (CT) autopsy. The studies were reviewed and evaluated for intravascular gas. The appearances and location of intravascular air were characterised. RESULTS Four cases of intravascular gas were identified out of 15 cases of CT autopsy performed from March 2004 to December 2006. In three cases, intravascular air was predominantly in the arterial system, coupled with severe pulmonary injury. In one case, the air was predominantly in the venous system with a large amount of gas in portal veins. CONCLUSION We propose to consider pulmonary alveoli-venous fistula as a possible cause of systemic air emboli, as identified on CT autopsy by large amounts of gas in the arterial circulation, coupled with severe pulmonary injury.
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Affiliation(s)
- Olga R Brook
- Department of Diagnostic Imaging, Rambam Health Care Campus, Haifa, Israel.
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6
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Ishida M, Gonoi W, Hagiwara K, Takazawa Y, Akahane M, Fukayama M, Ohtomo K. Intravascular gas distribution in the upper abdomen of non-traumatic in-hospital death cases on postmortem computed tomography. Leg Med (Tokyo) 2011; 13:174-9. [PMID: 21561795 DOI: 10.1016/j.legalmed.2011.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/14/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the occurrence of intravascular gas in the liver, kidneys, spleen, and pancreas by postmortem computed tomography (PMCT) in cases of non-traumatic in-hospital deaths and elucidate the relationship between the PMCT data and clinical information or autopsy results. METHODS The study included 45 cadavers of patients who died while receiving treatment in our academic tertiary-care hospital between April and December 2009. All subjects underwent PMCT and conventional autopsy. The appearance of postmortem gas in the liver, kidney, spleen, and pancreas was assessed using PMCT and scored using a subjective scale (liver, L0-L3; kidney, K0-K2; spleen, S0-S1; and pancreas, P0-P1), and the distribution of gases in the vessels of the liver (arteries, veins, and portal veins) was analyzed. The relationship between the gas score and time elapsed since death, cardiopulmonary resuscitation (CPR), administration of antibiotics, a history of bacteremia, or cause of death was assessed statistically. RESULTS Positive correlations were found between administration of CPR and liver and kidney gas scores (P=0.008 and 0.002, respectively), but not with spleen and pancreas gas (P=0.291 and 0.535, respectively). No significant relationship between distribution of gas in the vessels of the liver and CPR was found. No other significant correlations between gas and any of the other parameters described above were found. While significant correlations were detected in no-CPR cases between liver gas, kidney gas, spleen gas, and pancreas gas (P<0.001 for all six combinations), no correlation between these parameters was detected in the CPR cases. CONCLUSIONS The present study was the first statistical analysis of intravascular gas in the liver, kidneys, spleen, and pancreas by using PMCT in non-traumatic in-hospital death cases. The results showed that PMCT in the presence and absence of CPR reveals differences in intraorgan gas distribution. In addition, the detection of intraorgan gas on PMCT cannot be used to predict time elapsed since death, and it is not affected by the administration of antibiotics, a history of bacteremia, and cause of death. Awareness of these postmortem changes is important for the accurate interpretation of PMCT results.
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Affiliation(s)
- Masanori Ishida
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Arena V, Capelli A. Venous air embolism after cardiopulmonary resuscitation: the first case with histological confirmation. Cardiovasc Pathol 2010; 19:e43-4. [DOI: 10.1016/j.carpath.2008.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 10/02/2008] [Indexed: 12/12/2022] Open
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8
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Shiotani S, Ueno Y, Atake S, Kohno M, Suzuki M, Kikuchi K, Hayakawa H. Nontraumatic postmortem computed tomographic demonstration of cerebral gas embolism following cardiopulmonary resuscitation. Jpn J Radiol 2010; 28:1-7. [DOI: 10.1007/s11604-009-0372-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 08/26/2009] [Indexed: 11/24/2022]
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Weiss KL, Macura KJ, Ahmed A. Cerebral air embolism: acute imaging. J Stroke Cerebrovasc Dis 2009; 7:222-6. [PMID: 17895086 DOI: 10.1016/s1052-3057(98)80012-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/1997] [Accepted: 09/30/1997] [Indexed: 01/13/2023] Open
Abstract
Iatrogenic cerebral air embolism secondary to right subclavian vein recatheterization was imaged acutely by computed tomography (CT) and magnetic resonance imaging (MRI). However, CT showed intravascular air with misleadingly high attenuation values sampled to a minimum of -39 HU. Diffusion-weighted imaging, not previously reported in this setting, clearly showed hyperintense acute infarctions in corresponding vascular territories 8.5 hours postprocedure (less than 6 hours after referable symptomatology noted), whereas T2-weighted fluid-attenuated inversion recovery and turbo gradient spin echo images did not. The combination of CT and diffusion-weighted MRI appears ideal for evaluating suspected cerebral air embolism in the acute setting.
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Affiliation(s)
- K L Weiss
- Department of Radiology, The Medical College of Georgia, Augusta, GA, USA
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10
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Buschmann CT, Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med 2008; 35:397-404. [PMID: 18807013 DOI: 10.1007/s00134-008-1255-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 08/07/2008] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Resuscitation attempts require invasive iatrogenic manipulations on the patient. On the one hand, these measures are essential for survival, but on the other hand can damage the patient and thus contain a significant violation risk of both medical and forensic relevance for the patient and the physician. We differentiate between frequent and rare resuscitation-related injuries. Factors of influence are duration and intensity of the resuscitation attempts, sex and age of the patient as well as an anticoagulant medication. MATERIALS AND METHODS Review of current literature and report on autopsy cases from our institute (approximately 1,000 autopsies per year). RESULTS Frequent findings are lesions of tracheal structures and bony chest fractures. Rare injuries are lesions of pleura, pericardium, myocardium and other internal organs as well as vessels, intubation-related damages of neural and cartilaginous structures in the larynx and perforations of abdominal organs such as liver, stomach and spleen. CONCLUSION We differentiate between frequent and rare complications. The risk of iatrogenic CPR-related trauma is even present with adequate execution of CPR measures and should not question the employment of proven medical techniques.
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Affiliation(s)
- Claas T Buschmann
- University Medical Centre Charité, University of Berlin, Institute of Legal Medicine and Forensic Sciences, Berlin, Germany.
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11
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Andriessen P, Halbertsma F, van Lijnschoten G, Weerdenburg H, Bambang Oetomo S. Systemic air embolism after cardiopulmonary resuscitation in a preterm infant. Acta Paediatr 2008; 97:822-4. [PMID: 18397347 DOI: 10.1111/j.1651-2227.2008.00767.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
UNLABELLED We report a preterm infant with extensive systemic air embolism after cardiopulmonary resuscitation for cardiac arrest due to an occluding thrombus in the inferior vena cava. After excluding other potential causes (air infusion, necrotizing enterocolitis or pulmonary leakage syndrome), we postulate that the pressure gradient needed for air embolism to occur is related to the resuscitation procedure. An important clue of air embolism was noted on the chest X-ray taken before death showing intracardial air. CONCLUSION Systemic air embolism may occur as a very rare complication after cardiopulmonary resuscitation.
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Affiliation(s)
- P Andriessen
- Máxima Medical Center, Neonatal Intensive Care Unit, Veldhoven, The Netherlands.
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12
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van Rijn RR, Knoester H, Maes A, van der Wal AC, Kubat B. Cerebral arterial air embolism in a child after intraosseous infusion. Emerg Radiol 2008; 15:259-62. [PMID: 18247071 PMCID: PMC2480503 DOI: 10.1007/s10140-007-0681-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 10/19/2007] [Indexed: 01/06/2023]
Abstract
Cerebral arterial air embolism (CAAE) has been reported as a rare complication of medical intervention. There has been one reported case of CAAE after the use of an intraosseous infusion (IO) system. We report on a case of CAAE after tibial IO infusion in a 7-month-old girl during resuscitation.
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Affiliation(s)
- R R van Rijn
- Department of Radiology, Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands.
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13
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Park DH, Chung YG, Kang SH, Park JY, Park YK, Lee HK. Arterial cerebral air embolism at the site of a spontaneous pontine hemorrhage in a patient receiving erroneous continuous positive pressure ventilation. Clin Neurol Neurosurg 2007; 109:803-5. [PMID: 17681687 DOI: 10.1016/j.clineuro.2007.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 06/23/2007] [Accepted: 06/26/2007] [Indexed: 11/20/2022]
Abstract
We report the case of a 48-year-old male with iatrogenic arterial cerebral air embolism at the site of a spontaneous pontine hemorrhage. The patient inadvertently received continuous positive pressure ventilation without exhalation for a few minutes, resulting in pneumothorax, interstitial emphysema, pneumoperitoneum, and arterial cerebral air embolism at the site of the intracerebral hemorrhage. This is the first report of pneumocephalus without head trauma or previous surgery in which the air embolism occurs at the site of a spontaneous intracerebral hemorrhage. We hypothesize that air preferentially leaked into the brain parenchyma through the weakened perforating pontine artery that caused the intracerebral bleeding.
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Affiliation(s)
- Dong-Hyuk Park
- Department of Neurosurgery, Korea University, College of Medicine, Seoul 136-705, South Korea
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14
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Hwang SL, Lieu AS, Lin CL, Liu GC, Howng SL, Kuo TH. Massive cerebral air embolism after cardiopulmonary resuscitation. J Clin Neurosci 2005; 12:468-9. [PMID: 15925785 DOI: 10.1016/j.jocn.2004.03.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 03/24/2004] [Indexed: 11/30/2022]
Abstract
We report a case of massive intracerebral air embolism after cardiopulmonary resuscitation in a patient with a fatal head injury. There was no pneumothorax or extravascular pneumocephalus, however, air was found in the internal carotid artery. Massive cerebral air embolism may occur after entrance of air into the circulatory system via ruptured pulmonary vessels during cardiopulmonary resuscitation.
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Affiliation(s)
- Shiuh-Lin Hwang
- Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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15
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Kuo TH, Lee KS, Lieu AS, Lin CL, Liu GC, Howng SL, Hwang SL. Massive intracerebral air embolism associated with meningitis and lumbar spondylitis: case report. SURGICAL NEUROLOGY 2004; 62:362-5; discussion 365. [PMID: 15451293 DOI: 10.1016/j.surneu.2003.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Accepted: 11/26/2003] [Indexed: 04/30/2023]
Abstract
BACKGROUND Massive intracerebral air embolism is a rare pathologic state and never in association with meningitis and lumbar spondylitis. To the best of our knowledge, our presented case is the first of a massive intracerebral air embolism associated with meningitis and lumbar spondylitis of Klebsiella pneumonia. CASE DESCRIPTION A 55-year-old man presented with a high fever and low back pain. Blood culture showed Klebsiella pneumonia. Lumbar computed tomography (CT) revealed discitis at L1-2 and L2-3 levels and paraspinal abscess in which air was found. Despite management with antibiotics, patient's consciousness deteriorated, and brain CT revealed diffuse intravenous air embolism and severe brain swelling. Cerebrospinal fluid (CSF) examination demonstrated bacterial meningitis, and the CSF culture showed Klebsiella pneumonia. Later, septic shock occurred and patient expired. CONCLUSION Intracerebral air embolism can occur in the Klebsiella pneumonia meningitis that resulted from lumbar spondylitis and sepsis.
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Affiliation(s)
- T H Kuo
- Armed Forces Tso Ying Hospital, Kaohsiung, Taiwan
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17
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CT pneumoangiogram sign following cardiopulmonary resuscitation: detrimental cerebral air embolism or postmortal blood replacement with air? ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1571-4675(03)00027-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Pneumoangiography. J Neurosurg 2000. [DOI: 10.3171/jns.2000.93.5.0911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hashimoto Y, Yamaki T, Sakakibara T, Matsui J, Matsui M. Cerebral air embolism caused by cardiopulmonary resuscitation after cardiopulmonary arrest on arrival. THE JOURNAL OF TRAUMA 2000; 48:975-7. [PMID: 10823549 DOI: 10.1097/00005373-200005000-00029] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Y Hashimoto
- Department of Neurosurgery, Kyoto Kujo Hospital, Japan
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20
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Dexter F, Hindman BJ. Recommendations for Hyperbaric Oxygen Therapy of Cerebral Air Embolism Based on a Mathematical Model of Bubble Absorption. Anesth Analg 1997. [DOI: 10.1213/00000539-199706000-00006] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Dexter F, Hindman BJ. Recommendations for hyperbaric oxygen therapy of cerebral air embolism based on a mathematical model of bubble absorption. Anesth Analg 1997; 84:1203-7. [PMID: 9174293 DOI: 10.1097/00000539-199706000-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transcranial doppler studies show that microscopic cerebral artery air emboli (CAAE) are present in virtually all patients undergoing cardiac surgery. Massive cerebral arterial air embolism is rare. If it occurs, hyperbaric oxygen therapy (HBO) is recommended as soon as surgery is completed. We used a mathematical model to predict the absorption time of CAAE, assuming that the volumes of clinically relevant CAAE vary from 10(-7) to at least 10(-1) mL. Absorption times are predicted to be at least 40 h during oxygenation using breathing gas mixtures of fraction of inspired oxygen approximately equal to 40%. When CAAE are large enough to be detected by computerized tomography, absorption times are calculated to be at least 15 h. Decreases in cerebral blood flow caused by the CAAE would make the absorption even slower. Our analysis suggests that if the diagnosis of massive CAAE is suspected, computerized tomography should be performed, and consideration should be given to HBO therapy if the CAAE are large enough to be visualized, even if patient transfer to a HBO facility will require several hours.
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Affiliation(s)
- F Dexter
- Department of Anesthesia, University of Iowa, Iowa City 52242, USA.
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22
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Iwama T, Andoh H, Murase S, Miwa Y, Ohkuma A. Diffuse cerebral air embolism following trauma: striking postmortem CT findings. Neuroradiology 1994; 36:33-4. [PMID: 8107993 DOI: 10.1007/bf00599191] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Iwama
- Department of Neurosurgery, Prefectural Gifu Hospital, Japan
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23
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Shiina G, Shimosegawa Y, Kameyama M, Onuma T. Massive cerebral air embolism following cardiopulmonary resuscitation. Report of two cases. Acta Neurochir (Wien) 1993; 125:181-3. [PMID: 8122547 DOI: 10.1007/bf01401849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cerebral air embolism can occur in a number of situations. We report two cases of massive cerebral arterial air embolism following cardiopulmonary resuscitation, and its mechanism is discussed.
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Affiliation(s)
- G Shiina
- Department of Neurosurgery, Sendai City Hospital, Miyagi, Japan
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24
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Golish JA, Pena CM, Mehta AC. Massive air embolism complicating Nd-YAG laser endobronchial photoresection. Lasers Surg Med 1992; 12:338-42. [PMID: 1508030 DOI: 10.1002/lsm.1900120316] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 63 year old male underwent 6,900 rads of external radiation for a squamous cell carcinoma of the left main bronchus. Recurrence of the tumor 8 months later was treated with 6,618 joules and patency of the left main bronchus was restored. Four months later, he developed complete atelectasis of the left lung requiring repeat laser. During the procedure he became hypotensive, bradycardic, and hypoxic due to a tension pneumothorax. Although treated promptly with thoracostomy tube drainage, the patient never awakened. CT scan of the brain demonstrated anoxic encephalopathy with air present in the right frontal lobe. Brain death was confirmed by an EEG and cerebral angiogram. Air embolism has been reported in conjunction with diagnostic procedures including therapeutic pneumothorax for tuberculosis, transthoracic needle biopsy of the lung, and positive pressure ventilation with or without pneumothorax. The only reported case of air embolism associated with laser was a small middle cerebral artery cerebro-vascular accident which was self limited. Its mechanism is unclear, but it is suspected to be due to a communication between a pulmonary vein and the atmosphere. A greater volume of air will enter the damaged vessel in the setting of positive pressure ventilation and/or a tension pneumothorax. When neurologic manifestations are present, hyperbaric oxygen therapy is the treatment of choice. Prompt institution in hemodynamically stable patients can minimize neurologic sequelae.
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Affiliation(s)
- J A Golish
- Department of Pulmonary Diseases, Cleveland Clinic Foundation, Ohio 44195
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