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AJNR. American Journal of Neuroradiology 2014Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1... (Review)
Review
Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1 and 2, depending on the clinical presentation. MR imaging is currently the most accurate neuroimaging technique available for the detection of brain and spinal cord lesions in neurologic type 2 decompression sickness. Rapid bubble formation in tissues and the bloodstream during ascent is the basic pathophysiologic mechanism in decompression illness. These bubbles can damage the central nervous system through different mechanisms, namely arterial occlusion, venous obstruction, or in situ toxicity. Neuroimaging studies of decompression sickness have reported findings associated with each of these mechanisms: some typical results are summarized and illustrated in this article. We also review the limitations of previous work and make practical methodologic suggestions for future neuroimaging studies.
Topics: Brain Diseases; Decompression Sickness; Diving; Embolism, Air; Humans; Neuroimaging; Spinal Cord Diseases
PubMed: 24924550
DOI: 10.3174/ajnr.A4005 -
The Malaysian Journal of Pathology Apr 2023PMCT is superior to autopsy for identification of intravascular or extravascular gas pockets and their distribution. However, differentiation between air embolism and...
INTRODUCTION
PMCT is superior to autopsy for identification of intravascular or extravascular gas pockets and their distribution. However, differentiation between air embolism and putrefactive gas can prove challenging due to overlapping imaging findings.
CASE REPORT
We report a case of a healthy young man who was involved in a fight, sustained a slash wound to the right side of his head by a kitchen knife and died at the scene. Pre-autopsy PMCT demonstrated complex fractures of the right mastoid bone extending to the right petrous apex and jugular bulb, exposing the right sigmoid sinus. There was also asymmetric intravascular air distribution suspicious of air embolism with ancillary findings of traumatic carotid-jugular pseudoaneurysm and arteriovenous fistulous formation. Post-mortem examination revealed a slash wound measuring 12x2 cm at the right side of the head, cutting through the scalp, right temporal bone, right temporal meninges, right sigmoid venous sinus and part of the right occipital lobe. No intracranial haemorrhage was found on both PMCT and autopsy.
DISCUSSION
PMCT findings of air embolism versus putrefactive air on PMCT are discussed in this case. Detailed history on mechanism, circumstances, time of death and careful analysis of intravascular and extravascular air distribution patterns on PMCT are essential in guiding differentiation of true fatal air embolism and "normal" post-mortem putrefactive air. Needless to say, it is recommended that PMCT be performed as early as possible after death to reduce the chances and presence of artifactual decomposition changes.
Topics: Male; Humans; Embolism, Air; Tomography, X-Ray Computed; Autopsy; Arteriovenous Fistula
PubMed: 37119255
DOI: No ID Found -
Anesthesiology May 1986Transcutaneous oxygen tension (PtcO2) and transcutaneous carbon dioxide tension (PtcCO2) were monitored in 60 patients undergoing neurosurgical procedures. Twenty-six... (Comparative Study)
Comparative Study
Transcutaneous oxygen tension (PtcO2) and transcutaneous carbon dioxide tension (PtcCO2) were monitored in 60 patients undergoing neurosurgical procedures. Twenty-six patients were in the sitting position and underwent routine monitoring for air embolism. Seventeen episodes of air embolism were diagnosed by precordial Doppler ultrasound or transesophageal echocardiography, and the PtcO2 decreased early during the course of each episode. The mean PtcO2 decrease was 48 +/- 35 mmHg. During ten episodes the end-tidal carbon dioxide tension (PETCO2) decreased but only after the PtcO2 had already begun to decrease. PtcCO2 increased during air embolism but PETCO2 changes preceded the change in PtcCO2 by 1-2 min. Transcutaneous values during air embolism were verified with simultaneous arterial blood gas values during six air embolism episodes. A strong positive correlation was found between transcutaneous and arterial oxygen and carbon dioxide tensions. Correcting the PtcCO2 by the patient's baseline PtcCO2/PaCO2 ratio, PtcCO2 monitoring correctly reflected hypocarbia, normocarbia, and hypercarbia in 92% of the cases. PtcO2 monitoring was useful in detecting venous air embolism and may respond sooner than PETCO2. PtcCO2 monitoring was not useful as an early detector of air embolism.
Topics: Adult; Aged; Anesthesia; Carbon Dioxide; Echocardiography; Embolism, Air; Esophagus; Evaluation Studies as Topic; Female; Humans; Intraoperative Complications; Male; Mass Spectrometry; Middle Aged; Monitoring, Physiologic; Neurosurgical Procedures; Oximetry; Oxygen; Posture; Pulmonary Gas Exchange; Regression Analysis; Ultrasonography
PubMed: 3083725
DOI: 10.1097/00000542-198605000-00002 -
Journal of Medical Case Reports Feb 2024Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for...
BACKGROUND
Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting.
CASE PRESENTATION
This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week.
CONCLUSIONS
This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.
Topics: Humans; Female; Middle Aged; Embolism, Air; Liver Transplantation; Thrombosis; Heart Diseases; Echocardiography, Transesophageal; Intraoperative Complications; Liver Neoplasms; Pulmonary Embolism
PubMed: 38368412
DOI: 10.1186/s13256-024-04376-8 -
CMAJ : Canadian Medical Association... Aug 2017
Topics: Contrast Media; Diagnosis, Differential; Embolism, Air; Female; Humans; Injections, Intravenous; Middle Aged; Pulmonary Embolism; Tomography, X-Ray Computed
PubMed: 28827438
DOI: 10.1503/cmaj.170265 -
Proceedings of the National Academy of... Jun 2021An 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...
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.
Topics: Air; Animals; Blood Vessels; Cell Aggregation; Embolism, Air; Friction; Lubrication; Rabbits; Rheology
PubMed: 34155104
DOI: 10.1073/pnas.2025406118 -
The British Journal of Radiology Jan 2019Gas does not occur naturally in the cardiovascular system, although it is not unusual to identify it on imaging. The true incidence is difficult to know as asymptomatic... (Review)
Review
Gas does not occur naturally in the cardiovascular system, although it is not unusual to identify it on imaging. The true incidence is difficult to know as asymptomatic cases are rarely recorded. In iatrogenic instance, this occurs when atmospheric air enters the cardiovascular system from a high to low pressure, or when gas is forcibly injected into a vessel. The source of air must be promptly identified and treatment must be expedited to reduce morbidity and mortality. This pictorial review aims to give an overview of the causes (with particular emphasis on the conditions that may be encountered by a Radiologist), appearances of cardiovascular gas, and any subsequent treatment.
Topics: Adult; Aged; Aged, 80 and over; Cardiovascular System; Cause of Death; Diagnostic Imaging; Embolism, Air; Female; Humans; Male; Middle Aged; Risk Assessment; Survival Rate
PubMed: 30028184
DOI: 10.1259/bjr.20180121 -
Anaesthesia Jul 2009Using intra-cardiac echocardiography in anaesthetised swine we tested the hypotheses that embolised air (i) passes immediately through the right atrium into the...
Using intra-cardiac echocardiography in anaesthetised swine we tested the hypotheses that embolised air (i) passes immediately through the right atrium into the ventricle; (ii) persists in the right ventricle for a long time; (iii) is detectable for longer within the right ventricle or main pulmonary artery than the right atrium, and (iv) right ventricular aspiration recovers more air than right atrial aspiration. Following intravenous injection of different air volumes the air appeared in the right atrium in a mean (95% CI) of 3 s (2.5-3.5 s) and almost simultaneously in the right ventricle after 5 s (3.9-6.0 s), but air persisted for longer in the right ventricle (420 s; (367-473 s)) and pulmonary artery (541 s; (475-606 s)) than in the right atrium (404 s (353-457 s)), particularly with larger air volumes and in the semi-upright position. More air was recovered via a right ventricular catheter than an atrial catheter (52% vs 25%, p < 0.01).
Topics: Air Movements; Animals; Coronary Circulation; Disease Models, Animal; Embolism, Air; Heart Atria; Heart Ventricles; Male; Posture; Pulmonary Artery; Suction; Sus scrofa; Ultrasonography
PubMed: 19624631
DOI: 10.1111/j.1365-2044.2009.05936.x -
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 -
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