Pearls & Oy-sters: Enhancing vigilance for detection of cerebral air embolism

Retrograde Cerebral Air Embolism Associated With Bronchovenous Fistula

Cerebral air embolism is a rare event and predominantly iatrogenic. Here we present a case of spontaneous intravascular cerebral air embolism caused by lung cancer, which is among the other previously reported cases worldwide. A 69-year-old man with small cell lung carcinoma presented after being found unconscious. Computed tomography (CT) of the chest revealed a lung mass eroding into the superior vena cava (SVC) and with communication to the right upper lobe bronchus. As the patient's neurologic status deteriorated further, serial CT scans of the brain noted multiple air emboli with development of left cerebral infarction, and death followed shortly after. This case highlights the rapid progression of this rare condition and thereby the need to be familiar with the clinical setting in which the presence of cerebral air embolism can occur.

Paradoxical and Retrograde Air Embolism from Pressurized Peripheral Bolus

Introduction

Cerebral air embolism is a rare, yet serious neurological occurrence with unclear incidence and prevalence. Here, we present a case of fatal cerebral arterial and venous cerebral gas embolism in a patient with infective endocarditis and known large right-to-left shunt and severe tricuspid regurgitation following pressurized fluid bolus administration. Case Presentation. A 32-year-old female was admitted to the medical intensive care unit from a long-term acute care facility with acute on chronic respiratory failure. Her medical history was significant for intravenous heroin and cocaine abuse, methicillin-sensitive Staphylococcus aureus tricuspid valve infective endocarditis on vancomycin, patent foramen ovale, septic pulmonary embolism with cavitation, tracheostomy with chronic ventilator dependence, multifocal cerebral infarction, hepatitis C, nephrolithiasis, anxiety, and depression. After intravenous fluid administration, she became unresponsive with roving gaze, sluggish pupils, and hypotensive requiring vasopressors. CT of the brain showed diffuse arterial and venous cerebral air embolism secondary to accidental air administration from fluid bolus. Magnetic resonance imaging of the brain showed diffuse global anoxic injury and flattening of the globe at the optic nerve insertion. Given poor prognosis, her family chose comfort measures and she died.

Conclusions

Fatal cerebral air embolism can occur through peripheral intravenous routes when the lines are inadequately primed and fluids administered with pressure. Caution must be exercised in patients with right-to-left shunting as air may gain access to systemic circulation.

Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy: Case report

INTRODUCTION

Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism.

PATIENT CONCERNS

We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers.

DIAGNOSES

Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made.

INTERVENTIONS

The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation.

OUTCOMES

Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities.

CONCLUSIONS

While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.

Enhancing vigilance for cerebral air embolism after pneumonectomy: a case report

BACKGROUND

Vascular air embolism (VAE) is a rare but important complication that has not been paid enough attention to in the medical process such as surgery and anesthesia.

CASE PRESENTATION

We report for the first time that a 54-year-old male patient with central lung cancer developed severe complications of CAE after right pneumonectomy. After targeted first-aid measures such as assisted breathing, mannitol dehydration and antibiotic treatment, the patient gradually improved. The patient became conscious at discharge after 25 days of treatment but left limb was left with nerve injury symptoms.

CONCLUSION

We analyzed the possible causes of CAE in this case, and the findings from this report would be highly useful as a reference to clinicians.