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Diagnostics (Basel, Switzerland) Jan 2017Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We...
Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures at a tertiary medical center. Electronic medical records were searched for all cases of air embolism over a 25-year period; relevant medical and imaging records were reviewed. Sixty-seven air embolism cases were identified; the mean age was 59 years (range, 3-89 years). Ninety-four percent occurred in-hospital, of which 77.8% were during an operation/invasive procedure. Vascular access-related procedures (33%) were the most commonly associated with air embolism. Clinical signs and symptoms were related to the location the air embolus; 36 cases to the right heart/pulmonary artery, 21 to the cerebrum, and 10 were attributed to patent foramen ovale (PFO). Twenty-one percent of patients underwent hyperbaric oxygen therapy (HBOT), 7.5% aspiration of the air, and 63% had no sequelae. Mortality rate was 21%; 69% died within 48 hours. Thirteen patients had immediate cardiac arrest where mortality rate was 53.8%, compared to 13.5% ( = 0.0035) in those without. Air emboli were mainly iatrogenic, primarily associated with endovascular procedures. High clinical suspicion and early treatment are critical for survival.
PubMed: 28106717
DOI: 10.3390/diagnostics7010005 -
Radiology Case Reports Sep 2022Vascular air embolism (VAE) is an uncommon but potentially life-threatening event often associated with various procedures and diagnostic tests. Understanding this...
Vascular air embolism (VAE) is an uncommon but potentially life-threatening event often associated with various procedures and diagnostic tests. Understanding this challenging incident will enable physicians to evaluate, diagnose and manage this incident successfully. We present a case of a 73-year-old male who developed air in the right ventricle after intravenous contrast-enhanced computed tomography (CT) imaging. We aim at highlighting this challenging clinical scenario and emphasizing ways to assess the risks and implement means to prevent and treat accordingly.
PubMed: 35769117
DOI: 10.1016/j.radcr.2022.05.026 -
Annals of Gastroenterology 2019Air embolism is rarely diagnosed and is often fatal. The diagnosis is often not made in a timely manner given the rapid and severe clinical deterioration that often... (Review)
Review
Air embolism is rarely diagnosed and is often fatal. The diagnosis is often not made in a timely manner given the rapid and severe clinical deterioration that often develops, frequently leading to cardiac arrest. Many patients are only diagnosed post-mortem. With the increasing use of endoscopic retrograde cholangiopancreatography, air embolism should be considered in the differential diagnosis in patients who experience sudden clinical deterioration during or immediately after the procedure. Clinical suspicion is key in the diagnosis and management of air embolism. Use of precordial Doppler ultrasound and transesophageal echocardiogram can aid in the diagnosis of air embolism. Once the diagnosis is made, supportive management of airway, breathing and circulation is pivotal. Advanced cardiac life support should be initiated when necessary. Fluid resuscitation and vasopressors can improve cardiac output. Hyperbaric oxygen therapy should be considered when possible in cases of suspected cerebral air embolism cases to improve neurological outcome. A multidisciplinary team approach and effective communication with experts, potentially including an anesthesiologist, cardiologist, intensivist, radiologist and surgeon, can improve the outcome in air embolism.
PubMed: 30837788
DOI: 10.20524/aog.2018.0339 -
Radiologia 2021To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the... (Review)
Review
OBJECTIVE
To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.
CONCLUSION
In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).
Topics: Humans; Mediastinal Emphysema; Rupture; Subcutaneous Emphysema; Thorax; Trachea
PubMed: 34246426
DOI: 10.1016/j.rxeng.2021.02.005 -
The New England Journal of Medicine Oct 2017
Topics: Adult; Decompression Sickness; Embolism, Air; Humans; Male; Portal Vein; Radiography, Abdominal; Skin; Tomography, X-Ray Computed; Vomiting
PubMed: 29045210
DOI: 10.1056/NEJMicm1615505 -
Rechtsmedizin (Berlin, Germany) 2022Air embolisms are a common entity seen in clinical practice after traumatic or iatrogenic events. Cases of a suicidally induced air embolism are rare. The connectivity...
Air embolisms are a common entity seen in clinical practice after traumatic or iatrogenic events. Cases of a suicidally induced air embolism are rare. The connectivity of air-carrying and fluid-carrying tubing systems allow large gas volumes to be infused in a short period of time, usually with fatal outcome. In such cases, the use of computed tomography prior to autopsy is mandatory and provides a comprehensive visualization of introduced gas volumes. We present an unusual case of a suicidal gas embolism, in which a man in hospital connected a tube supplying oxygen to a venous catheter.
PubMed: 34539087
DOI: 10.1007/s00194-021-00528-y -
European Journal of Case Reports in... 2022Central venous lines are often inserted but their removal requires some precautions. We describe a 51-year-old female patient who was due for discharge but had an...
UNLABELLED
Central venous lines are often inserted but their removal requires some precautions. We describe a 51-year-old female patient who was due for discharge but had an unfortunate event arising from removal of her central venous line even though the appropriate measures had been taken. She experienced an acute ischaemic stroke secondary to air embolism. The deficits persisted even though extensive efforts were made to reverse them. This case reminds clinicians that bedside procedures can result in devastating complications even if all precautions have been followed. We review the mechanisms of air embolism, provide suggestions to limit its incidence following central line removal, and recommend therapeutic measures.
LEARNING POINTS
Precautions should be taken when removing a central venous line to reduce the risk of air embolism.Air embolism can manifest with acute stroke.Acute stroke in this setting requires hyperbaric oxygen therapy.
PubMed: 36415843
DOI: 10.12890/2022_003618 -
Scientific Reports Jul 2022Nearly two decades ago, pathologic examination results suggested that acoustic factors, such as mid-frequency active naval military sonar (MFAS) could be the cause of...
Nearly two decades ago, pathologic examination results suggested that acoustic factors, such as mid-frequency active naval military sonar (MFAS) could be the cause of acute decompression-like sickness in stranded beaked whales. Acute systemic gas embolism in these whales was reported together with enigmatic cystic liver lesions (CLL), characterized by intrahepatic encapsulated gas-filled cysts, tentatively interpreted as "gas-bubble" lesions in various other cetacean species. Here we provide a pathologic reinterpretation of CLL in odontocetes. Among 1,200 cetaceans necropsied, CLL were only observed in four striped dolphins (Stenella coeruleoalba), with a low prevalence (2%, N = 179). Together, our data strongly suggest that CLL are the result of the combination of a pre-existing or concomitant hepatic vascular disorder superimposed and exacerbated by gas bubbles, and clearly differ from acute systemic gas embolism in stranded beaked whales that is linked to MFAS. Budd-Chiari-like syndrome in dolphins is hypothesized based on the present pathologic findings. Nonetheless, further researched is warranted to determine precise etiopathogenesis(es) and contributing factors for CLL in cetaceans.
Topics: Animals; Dolphins; Embolism, Air; Leukemia, Lymphocytic, Chronic, B-Cell; Stenella; Whales
PubMed: 35879404
DOI: 10.1038/s41598-022-16947-0 -
Journal of Neurosurgery. Case Lessons Mar 2023This report describes the use of hyperbaric oxygen therapy for the acute management of an intraoperative air embolism encountered during a neurosurgical procedure....
BACKGROUND
This report describes the use of hyperbaric oxygen therapy for the acute management of an intraoperative air embolism encountered during a neurosurgical procedure. Furthermore, the authors highlight the concomitant diagnosis of tension pneumocephalus requiring evacuation prior to hyperbaric therapy.
OBSERVATIONS
A 68-year-old male developed acute ST-segment elevation and hypotension during elective disconnection of a posterior fossa dural arteriovenous fistula. The semi-sitting position had been used to minimize cerebellar retraction, raising the concern for acute air embolism. Intraoperative transesophageal echocardiography was utilized to establish the diagnosis of air embolism. The patient was stabilized on vasopressor therapy, and immediate postoperative computed tomography revealed air bubbles in the left atrium along with tension pneumocephalus. He underwent urgent evacuation for the tension pneumocephalus followed by hyperbaric oxygen therapy to manage the hemodynamically significant air embolism. The patient was eventually extubated and went on to fully recover; a delayed angiogram revealed complete cure of the dural arteriovenous fistula.
LESSONS
Hyperbaric oxygen therapy should be considered for an intracardiac air embolism resulting in hemodynamic instability. In the postoperative neurosurgical setting, care should be taken to exclude pneumocephalus requiring operative intervention prior to hyperbaric therapy. A multidisciplinary management approach facilitated expeditious diagnosis and management for the patient.
PubMed: 36941197
DOI: 10.3171/CASE2342 -
Indian Pediatrics Dec 2018Vascular air embolism (VAE) is rare but potentially lethal condition, and survival is rarely reported in newborn.
BACKGROUND
Vascular air embolism (VAE) is rare but potentially lethal condition, and survival is rarely reported in newborn.
CHARACTERISTICS
A preterm (27+1 weeks) neonate on Continuous positive airway pressure developed sudden cardiac asystole on day 3 of life and required 30 minutes of cardiopulmonary resuscitation.
OBSERVATION
Infant had air embolism in liver and brain. He survived but developed cystic encephalomalcia requiring extensive neuro-rehabilitation.
MESSAGE
Air embolism should be considered as differential diagnosis of sudden unexplained cardiac deterioration in well neonate.
Topics: Embolism, Air; Humans; Infant, Newborn; Infant, Premature, Diseases; Male
PubMed: 30745484
DOI: No ID Found