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Abstract
An air embolism is induced by intravascular bubbles that block the blood flow in vessels, which causes a high risk of pulmonary hypertension and myocardial and cerebral infarction. However, it is still unclear how a moving bubble is stopped in the blood flow to form an air embolism in small vessels. In this work, microfluidic experiments, in vivo and in vitro, are performed in small vessels, where bubbles are seen to deform and stop gradually in the flow. A clot is always found to originate at the tail of a moving bubble, which is attributed to the special flow field around the bubble. As the clot grows, it breaks the lubrication film between the bubble and the channel wall; thus, the friction force is increased to stop the bubble. This study illustrates the stopping process of elongated bubbles in small vessels and brings insight into the formation of air embolism.
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Yeung E, Adeboye A, Granet P, Casos S. Rare pathology in a trauma patient: air embolism following peripheral intravenous access. BMJ Case Rep 2021; 14:14/1/e240428. [PMID: 33509893 PMCID: PMC7845703 DOI: 10.1136/bcr-2020-240428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant's manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.
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Affiliation(s)
- Enoch Yeung
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Adeolu Adeboye
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Paul Granet
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Steven Casos
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
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Kugiyama T, Koganemaru M, Kuhara A, Nabeta M, Uchiyama Y, Tanaka N, Kawabata M, Abe T. A Rare Case of Cerebral Air Embolism Caused by Pulmonary Arteriovenous Malformation After Removal of a Central Venous Catheter. Kurume Med J 2018; 65:17-21. [PMID: 30158359 DOI: 10.2739/kurumemedj.ms651006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cerebral air embolism following central venous catheter (CVC) removal is extremely rare. We report a case of cerebral air embolism with loss of consciousness after removal of CVC caused by pulmonary arteriovenous malformation (PAVM). Computed tomography revealed air bubbles in the internal carotid arteries along the sulci in the cerebral hemispheres, as well as a PAVM. The cerebral air embolism was treated with hyperbaric oxygen and intravenous thrombolytic therapy, and transcatheter embolization of the PAVM was performed. When inserting/removing CVC in a patient with a small PAVM, treatment of the PAVM, irrespective of its size, could prevent the type of complication that occurred in our present case.
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Affiliation(s)
- Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine
| | | | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine
| | - Masakazu Nabeta
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine
| | - Yusuke Uchiyama
- Department of Radiology, Kurume University School of Medicine
| | | | | | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine
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Kalani MYS, Park MS, Kilburg C, Taussky P. Cerebral air embolism treated with endovascular flow reversal and suction aspiration. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Togo M, Hoshi T, Matsuoka R, Imai Y, Kohara N. Multiple small hemorrhagic infarcts in cerebral air embolism: a case report. BMC Res Notes 2017; 10:599. [PMID: 29145881 PMCID: PMC5691610 DOI: 10.1186/s13104-017-2925-x] [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: 09/14/2016] [Accepted: 11/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Cerebral air embolism is a rare cause of cerebral infarction. In cerebral air embolism, T2 star-weighted imaging shows numerous spotty hypointense signals. Previous reports have suggested that these signals represent air in the brain and are gradually diminished and absorbed. We experienced two cases of cerebral air embolism, and in one of them, we conducted an autopsy. Case presentation Case 1 was a 76-year-old Japanese man with lung cancer and emphysema. A spasmodic cough induced massive cerebral and cardiac air embolisms and the patient died because of cerebral herniation. T2 star-weighted imaging of brain magnetic resonance imaging showed multiple spotty low signals. Brain autopsy showed numerous spotty hemorrhagic infarcts in the area of T2 star-weighted imaging signals. Case 2 was an 85-year-old Japanese man with emphysema who suffered from acute stroke. Similar spotty T2 star-weighted imaging signals were observed and remained unchanged 2 months after the onset. Conclusions These findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain.
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Affiliation(s)
- Masaya Togo
- Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan. .,Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Taku Hoshi
- Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Ryosuke Matsuoka
- Department of Pathology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan
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Wong SSM, Kwaan HC, Ing TS. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters. Clin Kidney J 2017; 10:797-803. [PMID: 29225809 PMCID: PMC5716215 DOI: 10.1093/ckj/sfx064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/26/2017] [Indexed: 12/21/2022] Open
Abstract
Venous air embolism is a dreaded condition particularly relevant to the field of nephrology. In the face of a favourable, air-to-blood pressure gradient and an abnormal communication between the atmosphere and the veins, air entrance into the circulation is common and can bring about venous air embolism. These air emboli can migrate to different areas through three major routes: pulmonary circulation, paradoxical embolism and retrograde ascension to the cerebral venous system. The frequent undesirable outcome of this disease entity, despite timely and aggressive treatment, signifies the importance of understanding the underlying pathophysiological mechanism and of the implementation of various preventive measures. The not-that-uncommon occurrence of venous air embolism, often precipitated by improper patient positioning during cervical catheter procedures, suggests that awareness of this procedure-related complication among health care workers is not universal. This review aims to update the pathophysiology of venous air embolism and to emphasize the importance of observing the necessary precautionary measures during central catheter use in hopes of eliminating this unfortunate but easily avoidable mishap in nephrology practice.
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Affiliation(s)
- Steve Siu-Man Wong
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Hau C Kwaan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment. J Clin Med 2016; 5:jcm5110093. [PMID: 27809224 PMCID: PMC5126790 DOI: 10.3390/jcm5110093] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
Air embolism is a rarely encountered but much dreaded complication of surgical procedures that can cause serious harm, including death. Cases that involve the use of endovascular techniques have a higher risk of air embolism; therefore, a heightened awareness of this complication is warranted. In particular, central venous catheters and arterial catheters that are often placed and removed in most hospitals by a variety of medical practitioners are at especially high risk for air embolism. With appropriate precautions and techniques it can be preventable. This article reviews the causes of air embolism, clinical management and prevention techniques.
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Affiliation(s)
- Colin J McCarthy
- Massachusetts General Hospital, Harvard Medical School, Division of Interventional Radiology, 55 Fruit Street, GRB-290A, Boston, MA 02114, USA.
| | - Sasan Behravesh
- Mayo Clinic Arizona, Division of Vascular & Interventional Radiology, Phoenix, AZ 85054, USA.
| | - Sailendra G Naidu
- Mayo Clinic Arizona, Division of Vascular & Interventional Radiology, Phoenix, AZ 85054, USA.
| | - Rahmi Oklu
- Mayo Clinic Arizona, Division of Vascular & Interventional Radiology, Phoenix, AZ 85054, USA.
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Belton PJ, Nanda A, Alqadri SL, Khakh GS, Chandrasekaran PN, Newey C, Humphries WE. Republished: Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration. J Neurointerv Surg 2016; 9:e10. [DOI: 10.1136/neurintsurg-2016-012535.rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/21/2022]
Abstract
Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed.
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Belton PJ, Nanda A, Alqadri SL, Khakh GS, Chandrasekaran PN, Newey C, Humphries WE. Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration. BMJ Case Rep 2016; 2016:bcr-2016-012535. [PMID: 27435840 DOI: 10.1136/bcr-2016-012535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed.
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Affiliation(s)
- Patrick J Belton
- Division of Neurosurgery, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
| | | | - Syeda L Alqadri
- Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
| | - Gurpreet S Khakh
- Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
| | | | - Christopher Newey
- Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
| | - William E Humphries
- Division of Neurosurgery, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
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