-
Journal of Cancer Research and... 2018The objective of the study is to explore the etiology, clinical manifestations, imaging features, diagnosis, treatment, and prognosis of cerebral air embolism... (Review)
Review
PURPOSE
The objective of the study is to explore the etiology, clinical manifestations, imaging features, diagnosis, treatment, and prognosis of cerebral air embolism complicated computed tomography (CT) scan-guided percutaneous liver biopsy.
MATERIALS AND METHODS
A case of air embolism was developed in the brain during a CT-guided percutaneous needle biopsy of the liver. In addition, retrospective analysis was performed on the previously reported typical cases of cerebral air embolism secondary to CT-guided percutaneous lung biopsy.
RESULTS
Cerebral air embolism has been recognized as a potentially fatal but extremely rare complication following CT-guided percutaneous liver or lung biopsy. It was usually caused by cough, positive pressure ventilation, incorrect puncture position, repeated punctures, cavity or cyst in the target sites, and vascular inflammatory lesions.
CONCLUSIONS
Clinicians should focus on timely and correct diagnosis of this complication during their interventional procedures. The current main treatment for this complication has been hyperbaric oxygen therapy.
Topics: Biopsy, Needle; Embolism, Air; Humans; Image Enhancement; Image-Guided Biopsy; Intracranial Embolism; Liver; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 30589054
DOI: 10.4103/jcrt.JCRT_1035_17 -
Journal of Endovascular Therapy : An... Jun 2023Air embolism (AE), especially when affecting the brain, is an underrated and potentially life-threatening complication in various endovascular interventions. This study...
BACKGROUND
Air embolism (AE), especially when affecting the brain, is an underrated and potentially life-threatening complication in various endovascular interventions. This study aims to investigate experimental AEs using a new model to generate micro air bubbles (MAB), to assess the impact of a catheter on these MAB, and to demonstrate the applicability of this model in vivo.
MATERIALS AND METHODS
Micro air bubbles were created using a system based on microfluidic channels. The MAB were detected and analyzed automatically. Micro air bubbles, with a target size of 85 µm, were generated and injected through a microcatheter. The MAB diameters proximal and distal to the catheter were assessed and compared. In a subsequent in vivo application, 2000 MAB were injected into the aorta (at the aortic valve) and into the common carotid artery (CCA) of a rat, respectively, using a microcatheter, resembling AE occurring during cardiovascular interventions.
RESULTS
Micro air bubbles with a highly calibrated size could be successfully generated (median: 85.5 µm, SD 1.9 µm). After passage of the microcatheter, the MAB were similar in diameter (median: 86.6 µm) but at a lower number (60.1% of the injected MAB) and a substantially higher scattering of diameters (SD 29.6 µm). In vivo injection of MAB into the aorta resulted in cerebral microinfarctions in both hemispheres, whereas injection into the CCA caused exclusively ipsilateral microinfarctions.
CONCLUSION
Using this new AE model, MAB can be generated precisely and reproducibly, resulting in cerebral microinfarctions. This model is feasible for further studies on the pathophysiology and prevention of AE in cardiovascular procedures.
Topics: Rats; Animals; Embolism, Air; Treatment Outcome; Brain; Aorta; Carotid Artery, Common
PubMed: 35255747
DOI: 10.1177/15266028221082010 -
General Thoracic and Cardiovascular... Oct 2019In this study, we aimed to determine conditions associated with the development of air bubbles in the pulmonary veins during lung resection. (Observational Study)
Observational Study
OBJECTIVES
In this study, we aimed to determine conditions associated with the development of air bubbles in the pulmonary veins during lung resection.
METHODS
A total of 28 patients who underwent lung resection at our institution between October 2016 and March 2018 were included in the study. An intraoperative transesophageal echocardiography was conducted, and the influx of air bubbles in the orifice of the pulmonary vein leading to the left atrium was observed during lung resection.
RESULTS
The median age of all patients was 75 years. The study included 13 men and 15 women. Moreover, seven, 14, and seven patients underwent wedge resection, segmentectomy, and lobectomy, respectively. The presence of air bubbles was observed in 15 patients and was detected when the lung parenchyma was cut (13 patients) or compressed (3 patients) using staplers and when an energy device was used (1 patient). No postoperative organ infarction occurred in any patients.
CONCLUSIONS
Although the presence of air bubbles was noted in the pulmonary vein during lung resection via transesophageal echocardiography, the clinical condition of the patients in our study did not deteriorate. The clinical significance of air bubbles is not clear. Therefore, more data about such events must be collected in future.
Topics: Aged; Aged, 80 and over; Echocardiography, Transesophageal; Embolism, Air; Female; Heart Atria; Heart Diseases; Humans; Lung Neoplasms; Male; Pneumonectomy; Tomography, X-Ray Computed
PubMed: 30941696
DOI: 10.1007/s11748-019-01112-8 -
JACC. Clinical Electrophysiology Sep 2020Air embolisms can lead to lethal results; however, few reports have systemically investigated this issue. Of 348 consecutive patients with atrial fibrillation who... (Review)
Review
Air embolisms can lead to lethal results; however, few reports have systemically investigated this issue. Of 348 consecutive patients with atrial fibrillation who underwent cryoballoon ablation, procedures were performed conventionally in 251 patients. In the remaining 97 patients, a water bucket was used while inserting the cryoballoon into the sheath. A total of 10 coronary air embolisms with ST-segment elevation in the inferior leads were observed among 9 (2.6%) patients. Multiple air bubbles were identified in 2 patients on emergent coronary angiography. All recovered under conservative treatment without any sequela. The incidence decreased when using the water bucket (1 of 97 [1.03%] vs. 8 of 251 [3.2%], p = 0.454).
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Embolism, Air; Humans; Pulmonary Veins; Treatment Outcome; Water
PubMed: 32972540
DOI: 10.1016/j.jacep.2020.07.012 -
The American Journal of Case Reports Apr 2024BACKGROUND A paradoxical air embolism (PAE) occurs when air entering the central venous circulation reaches the systemic circulation, occurring through an intracardiac...
BACKGROUND A paradoxical air embolism (PAE) occurs when air entering the central venous circulation reaches the systemic circulation, occurring through an intracardiac shunt or intrapulmonary shunting. Patients presenting for liver transplantation often have intrapulmonary shunting due to pulmonary arterial vasodilation, even in the absence of hepatopulmonary syndrome. Here, we present a case of hemodynamic collapse believed to be caused by a PAE, which was diagnosed intraoperatively with transesophageal echocardiography (TEE). CASE REPORT A 60-year-old man who was diagnosed with non-alcoholic steatohepatitis cirrhosis presented for deceased donor orthotopic liver transplantation with utilization of normothermic machine perfusion. Following reperfusion of the liver allograft, TEE detected intrapulmonary shunting resulting in air within the left atrium, left ventricle, and ascending aorta. The patient developed severe biventricular dysfunction with ST-segment changes on electrocardiography monitoring and became acutely hypotensive with significant hepatic congestion 5 min after liver reperfusion. High doses of inotropic and vasopressor support were used as well as inhaled nitric oxide. The patient recovered after 30 min of medical management. The liver transplantation operation was successfully completed and the patient was discharged home on postoperative day 7. CONCLUSIONS Intracardiac air at the time of reperfusion during liver transplantation can originate from the donor allograft and result in PAE in the setting of intrapulmonary shunting. PAE can result in intracoronary air and should be considered in cases of hemodynamic instability in liver transplantation, especially if air is seen within the left atrium, left ventricle, and ascending aorta.
Topics: Male; Humans; Middle Aged; Liver Transplantation; Embolism, Air; Liver Cirrhosis; Echocardiography, Transesophageal
PubMed: 38627956
DOI: 10.12659/AJCR.943042 -
Forensic Science, Medicine, and... Sep 2019A 16-month-old girl who was hospitalized with pneumonia and treated with antibiotics died after the nurse erroneously connected her intravenous left forearm catheter to...
A 16-month-old girl who was hospitalized with pneumonia and treated with antibiotics died after the nurse erroneously connected her intravenous left forearm catheter to the oxygen supply. Autopsy revealed an impressive gas embolism in the left subclavian and brachiocephalic veins, reduced crepitus and enlarged lung volume, and congestion of the meningeal vessels with some areas showing small air bubbles. Dilation of the right atrium and the right ventricle with efflux under pressure of large amounts of air bubbles were observed. The coronary arteries and veins were filled with air bubbles intercalated with segments containing blood. After exclusion of putrefactive artifacts as the source of such a large amount of gas in the body death was considered to be due to a massive air embolism. While embolisms are well recognized in adults, these cases are only infrequently encountered in forensic practice in younger decedents.
Topics: Anti-Bacterial Agents; Catheterization, Peripheral; Embolism, Air; Female; Humans; Infant; Medical Errors; Oxygen; Pneumonia
PubMed: 30635779
DOI: 10.1007/s12024-018-0072-x -
Journal of Veterinary Internal Medicine Mar 2018Venous air embolism is a potentially life-threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have...
BACKGROUND
Venous air embolism is a potentially life-threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have been reported in the literature and the prognosis is currently unknown.
HYPOTHESIS/OBJECTIVES
Our objective was to describe the surrounding circumstances, clinical signs, treatment, progression, and outcome of venous air embolism in hospitalized horses.
ANIMALS
Thirty-two horses with acute onset of compatible clinical signs associated with IV catheter disconnection or damage.
METHODS
Multicenter retrospective study. Data extracted from clinical records included signalment, presenting complaint, catheter details, clinical signs, treatments, and outcome.
RESULTS
Most cases resulted from extension set disconnection occurring within approximately 24 hours after catheter placement. In fewer horses, extension set damage was cited as a cause. Common clinical signs included tachycardia, tachypnea, recumbency, muscle fasciculations and agitation, with abnormal behavior including kicking and flank biting. Less commonly, pathological arrhythmias or more severe neurologic signs, including blindness and seizures, were noted. Progression was unpredictable, with some affected horses developing delayed-onset neurologic signs. Mortality was 6/32 (19%), including 2 cases of sudden death and other horses euthanized because of persistent neurologic deficits. Negative outcomes were more common in horses with recorded blindness, sweating or recumbency, but blindness resolved in 5/8 affected horses.
CONCLUSIONS AND CLINICAL IMPORTANCE
The prognosis for resolution of clinical signs after air embolism is fair, but permanent neurologic deficits or pathologic cardiac arrhythmias can arise. Unpredictable progression warrants close monitoring. Systematic clinic-based surveillance could provide additional useful information to aid prevention.
Topics: Animals; Arrhythmias, Cardiac; Blindness; Embolism, Air; Horse Diseases; Horses; Nervous System Diseases; Retrospective Studies; Seizures; Vascular Access Devices
PubMed: 29460300
DOI: 10.1111/jvim.15057 -
Journal of Forensic Sciences Sep 2021Air embolism is often unrecognized and underreported. Published case reports or case series describe only rare fundal examinations of retinal air emboli (RAE)-a...
Air embolism is often unrecognized and underreported. Published case reports or case series describe only rare fundal examinations of retinal air emboli (RAE)-a distinctive sign of systemic air embolism. We report an infant, found unresponsive at home, who died in the emergency department after unsuccessful resuscitative efforts. Before the autopsy, diagnostic RAE were recognized and imaged during postmortem funduscopy. Postmortem radiography and an autopsy confirmed systemic (paradoxical) air embolism due to inflicted abdominal and thoracic blunt force injuries. While a few descriptions and illustrations of RAE occur in case reports, we found no published photographic images of RAE in infants, children, or adults. This case report describes and photographically documents classic RAE associated with fatal systemic (paradoxical) air embolism. Complementing postmortem radiography and judicious autopsy techniques, the detection of RAE can aid pathologists in diagnosing systemic air embolism.
Topics: Brain; Child Abuse; Embolism, Air; Humans; Infant; Ophthalmoscopy; Pneumoperitoneum; Retina; Retinal Hemorrhage; Rib Fractures; Skull; Subcutaneous Emphysema
PubMed: 34132391
DOI: 10.1111/1556-4029.14781 -
Artificial Organs Jun 2017The unique device architecture of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) requires dedicated and specific air-removal techniques during...
The unique device architecture of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) requires dedicated and specific air-removal techniques during device implantation in vivo. These procedures comprise special surgical techniques and intraoperative manipulations, as well as engineering design changes and optimizations to the device itself. The current study evaluated the optimal air-removal techniques during the Cleveland Clinic double-ended centrifugal CFTAH in vivo implants (n = 17). Techniques and pump design iterations consisted of developing a priming method for the device and the use of built-in deairing ports in the early cases (n = 5). In the remaining cases (n = 12), deairing ports were not used. Dedicated air-removal ports were not considered an essential design requirement, and such ports may represent an additional risk for pump thrombosis. Careful passive deairing was found to be an effective measure with a centrifugal pump of this design. In this report, the techniques and design changes that were made during this CFTAH development program to enable effective residual air removal and prevention of air embolism during in vivo device implantation are explained.
Topics: Animals; Cardiac Surgical Procedures; Cattle; Embolism, Air; Heart, Artificial; Prosthesis Design; Prosthesis Implantation; Thrombosis
PubMed: 27654489
DOI: 10.1111/aor.12775 -
Internal Medicine (Tokyo, Japan) 2017A 51-year-old man was admitted to have a nodule evaluated using chest computed tomography (CT). Shortly after curetting and transbronchial biopsies via bronchoscopy,...
A 51-year-old man was admitted to have a nodule evaluated using chest computed tomography (CT). Shortly after curetting and transbronchial biopsies via bronchoscopy, hypotension, bradycardia, unconsciousness, and left hemiplegia appeared and resolved within one hour. Head CT showed cerebral air embolism. The following day, lower left quadrant pain developed. Pneumatosis intestinalis on abdominal CT and elevation of creatine kinase and troponin T levels indicated air embolism in the mesenteric and coronary arteries. Some reports have documented cerebral air embolism alone after bronchoscopy; however, we should consider systemic air embolism, even when encountering a patient without specific symptoms related to any organ.
Topics: Bronchoscopy; Cerebral Arteries; Coronary Vessels; Embolism, Air; Humans; Male; Mesenteric Arteries; Middle Aged; Pneumatosis Cystoides Intestinalis; Tomography, X-Ray Computed
PubMed: 28381749
DOI: 10.2169/internalmedicine.56.7836