-
Neurocritical Care Jun 2024
Topics: Humans; Embolism, Air; Intracranial Embolism; Pneumonia, Necrotizing; Male; Middle Aged
PubMed: 38356078
DOI: 10.1007/s12028-023-01935-7 -
Internal Medicine (Tokyo, Japan) Mar 2020
PubMed: 31708543
DOI: 10.2169/internalmedicine.3396-19 -
Brain & NeuroRehabilitation Nov 2023Cerebral air embolism (CAE) occurs in various clinical situations such as surgery, angiography, and hemodialysis; most are iatrogenic. Here we report the case of a...
Cerebral air embolism (CAE) occurs in various clinical situations such as surgery, angiography, and hemodialysis; most are iatrogenic. Here we report the case of a 57-year-old man who developed CAE immediately after air-powder abrasive treatment, which is commonly used in dentistry. The patient underwent air-powder abrasive treatment for peri-implantitis, and immediately after the treatment, cardiac arrest occurred and cardio- pulmonary resuscitation was performed. After resuscitation, brain computed tomography performed in the emergency room showed scattered dark density presumed to be air. The day after admission, the patient showed right hemiplegia and a multifocal cerebral infarction was observed on brain magnetic resonance imaging. Therefore, CAE was strongly suspected. After hyperbaric oxygen treatment (HBOT), which started 4 days after the incident, the patient regained consciousness and showed improvement in cognitive impairment, and only grade 4 muscle weakness was observed in the right lower extremity on the manual muscle test. This case highlights the importance of considering CAE as a possible cause of neurological symptoms occurring during clinical procedures involving air, and adds to the accumulation of evidence of therapeutic effects of delayed HBOT.
PubMed: 38047095
DOI: 10.12786/bn.2023.16.e22 -
Acta Radiologica Open Jun 2022Systemic air embolism is a rare, however potentially fatal, low incidence, complication to CT-guided transthoracic needle biopsy of lung lesions. (Review)
Review
BACKGROUND
Systemic air embolism is a rare, however potentially fatal, low incidence, complication to CT-guided transthoracic needle biopsy of lung lesions.
PURPOSE
The purpose of this review of case reports and series was to pool data about this rare complication and glance for a pattern or similarities in the patients' initial symptoms and course, as well as the management of the patients in relation to current guidelines.
MATERIAL AND METHODS
PubMed was searched for case reports and case series about systemic air embolisms following CT-guided transthoracic needle biopsy of lung lesions from inception to November 2021. A reviewer screened the results for eligibility and included studies which reported at least two outcomes of interest. Data was extracted by one author and a descriptive analysis was conducted.
RESULTS
Of 1,136 studies screened, 83 were eligible for inclusion involving 97 patients. The mean age was 64.8±11.7 years and ≈60% of the patients were men. In 15 cases the outcome was fatal, and most of the fatal cases ( = 12) had cardiac arrest as the primary initial symptom. In addition to conventional oxygen therapy, 34 patients received hyperbaric oxygen therapy, and in 30 cases the physician in charge chose to change the patient from standard supine position to - most often - Trendelenburg position.
CONCLUSION
No similarities were found that could lead to more rapid diagnosis or more correct management. The staff should keep systemic air embolisms in mind, when more common complications are ruled out, and consider hyperbaric oxygen therapy in case of suspicion.
PubMed: 35770135
DOI: 10.1177/20584601221096680 -
The Journal of Invasive Cardiology Aug 2019Coronary artery air embolism can be fatal if not proficiently managed. Vasospasm is said to be protective in that it breaks the larger air bubbles, as occurred in the...
Coronary artery air embolism can be fatal if not proficiently managed. Vasospasm is said to be protective in that it breaks the larger air bubbles, as occurred in the present case.
Topics: Angioplasty, Balloon, Coronary; Anterior Wall Myocardial Infarction; Coronary Angiography; Coronary Vessels; Drug-Eluting Stents; Embolism, Air; Humans; Male; Middle Aged
PubMed: 31368903
DOI: No ID Found -
The American Journal of Case Reports Oct 2020BACKGROUND Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral...
BACKGROUND Cerebral air embolism is a rare iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. The symptoms of cerebral air embolism are nonspecific and may be attributed to sedation-related complications and central nervous system insults. Having awareness of this rare iatrogenic event and deciding on immediate imaging when it is suspected are essential for prompt diagnosis and treatment. CASE REPORT A 72-year-old man with a past medical history of alcoholic liver cirrhosis with associated portal hypertension underwent an outpatient esophago-gastroduodenoscopy for surveillance of esophageal varices. During the procedure, the patient retched several times and developed a mucosal tear, which was repaired using endoscopic clips. After the procedure, the patient remained sedated for a prolonged time and was subsequently unresponsive. Nonenhanced CT of the head showed several foci of gas throughout the subarachnoid spaces. Follow-up nonenhanced brain magnetic resonance imaging demonstrated ischemic changes, which were more prominent along the right cerebral hemisphere. CONCLUSIONS Cerebral air embolism is an iatrogenic complication of endoscopic procedures that can result in irreversible neurological damage. It must be included in the differential diagnosis of a patient presenting with altered mental status and neurological deficits after an endoscopic procedure. Diagnostic imaging can be useful in identifying key features of this iatrogenic event. Timely diagnosis and treatment can improve patient outcomes.
Topics: Aged; Brain; Embolism, Air; Humans; Iatrogenic Disease; Magnetic Resonance Imaging; Male
PubMed: 33090976
DOI: 10.12659/AJCR.925046 -
Medicina (Kaunas, Lithuania) Jan 2022Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure... (Review)
Review
Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Manifestations of dysbarism range from itching and minor pain to neurological symptoms, cardiac collapse, and death. Overall, four clinical pictures can occur: decompression illness, barotrauma, inert gas narcosis, and oxygen toxicity. We will then review the clinical manifestations and illustrate some hints of therapy. We will first introduce the two forms of decompression sickness. In the next part, we will review the barotrauma, compression, and decompression. The last three parts will be dedicated to gas embolism, inert gas narcosis, and oxygen toxicity. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
Topics: Barotrauma; Decompression Sickness; Embolism, Air; Humans; Hyperbaric Oxygenation
PubMed: 35056412
DOI: 10.3390/medicina58010104 -
Urology Annals 2020In the present era, percutaneous nephrolithotomy (PCNL) is the standard treatment for large (>2 cm) renal or staghorn renal stones. Both air and iodinated contrast has...
INTRODUCTION
In the present era, percutaneous nephrolithotomy (PCNL) is the standard treatment for large (>2 cm) renal or staghorn renal stones. Both air and iodinated contrast has been used to opacify the pelvicalyceal system (PCS) before the dilatation of the tract. There are rare reports of air embolism following air pyelogram on mere presumptions.
MATERIALS AND METHODS
This is a prospective observational study. A total of 164 patients underwent PCNL in which air was used to opacify the PCS by placing a ureteric catheter for initial access.
RESULTS
None of our patients developed any complication during the procedure or in the postoperative period, which could be attributed to air embolism.
CONCLUSIONS
The present study ascertains that using air for opacification of PCS for initial puncture access is a safe and acceptable alternative to iodinated contrast.
PubMed: 32015618
DOI: 10.4103/UA.UA_10_19 -
Seminars in Interventional Radiology Dec 2014
Review
PubMed: 25435664
DOI: 10.1055/s-0034-1393975 -
Journal of the American College of... Oct 2022To provide recent population-based estimates of transthoracic needle biopsy (TTNB) complications and risk factors associated with these complications.
OBJECTIVE
To provide recent population-based estimates of transthoracic needle biopsy (TTNB) complications and risk factors associated with these complications.
METHODS
This retrospective cohort analysis included adults from a nationally representative longitudinal insurance claims data set who underwent TTNB in 2017 or 2018. Complications that were evaluated included pneumothorax, hemorrhage, and air embolism. Separate logistic regression models estimated the association of pneumothorax or hemorrhage with the setting of care (ie, inpatient or outpatient) and selected baseline patient demographic and clinical characteristics including age, gender, history of chronic obstructive pulmonary disease, diagnosis of pleural effusion, tobacco use, use of oral anticoagulants and antiplatelet agents, prior lung cancer screening, previous bronchoscopy within 1 year, and Elixhauser comorbidity index.
RESULTS
Among 16,971 patients who underwent TTNB, 25.8% experienced a complication within 3 days of the procedure (pneumothorax 23.3%, hemorrhage 3.6%, and air embolism 0.02%). Among patients who experienced pneumothorax, 31.9% required chest tube drainage. Among patients undergoing an outpatient TTNB (n = 12,443), 6.9% were hospitalized within 7 days. Biopsy in an inpatient setting, chronic obstructive pulmonary disease diagnosis, and prior bronchoscopy were associated with higher rates of both pneumothorax and hemorrhage. Prior lung cancer screening was associated with an increased risk of pneumothorax, and prior use of oral anticoagulants or antiplatelets was associated with higher rates of hemorrhage.
CONCLUSION
This contemporary population-based cohort study demonstrated that approximately one-quarter of patients undergoing TTNB experienced a complication. Pneumothorax was the most frequent complication, and hemorrhage and air embolism were rare. Among outpatients, complications from TTNB are an important cause of hospitalization.
Topics: Adult; Anticoagulants; Biopsy, Needle; Cohort Studies; Early Detection of Cancer; Embolism, Air; Hemorrhage; Humans; Image-Guided Biopsy; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Platelet Aggregation Inhibitors; Pneumothorax; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Risk Factors
PubMed: 35738412
DOI: 10.1016/j.jacr.2022.04.010