A rare interesting case of fatal air embolism after intravenous contrast during computed tomography

Naved Y Hasan,Asiah Salem Rugaan

doi:10.22141/2224-0586.17.4.2021.237734

Abstract

We are reporting a fatal case of air embolism. Although minor cases of air embolism may go unnoticed, this is a case of fatal air embolism after intravenous entry of air, which presented with sudden onset of pulseless electrical activity during a computed tomography scan in the radiology department, requiring cardiopulmonary resuscitation for 15 min. Subsequently, after admission to the intensive care unit, we achieved return of spontaneous circulation. The patient was intubated and ventilated in a shock state. He remained in refractory shock despite of supportive care. Cardiaс arrest was registered again in the catheterization lab and the patient could not be revived after 4 h from the initial cardiac arrest. А computed tomography scan was reported to reveal a significant amount of intra-cardiac air, which was the likely cause patient’s death. The case is a rare condition, which highlights the importance of early diagnosis and delivers a message to the medical staff to have a high index of suspicion in patients who have risk factors, and who develop sudden shock with hypoxemia, in order to treat this potentially life-threatening condition effectively in a timely manner.

Highlights

Fatal air embolism is a rare condition, because of entry of air into the venous or arterial vasculature, producing hemodynamic and systemic effects
Vascular air embolism is a known entity since the early nineteenth century
Its availability is limited to certain centers only. This case of massive air embolism reflects the importance of identifying an air embolism as early as possible

Summary

Introduction

Fatal air embolism is a rare condition, because of entry of air into the venous or arterial vasculature, producing hemodynamic and systemic effects This occurs during se veral operative or non-operative procedures, which involve communication with external air. He was a known case of non-insulin-dependent diabetes mellitus, hypertension, and cholecystectomy He presented with a 2-week history of passing black co lored stools, and feeling dizzy. At the end of CT scan, the patient developed PEA, which required CPR for 10–15 minutes. He was revived, intubated, ventilated, and transferred to the Intensive Care Unit. The patient was severely hypotensive with blood pressure 80/60 mm Hg, oxygen saturation was 98 % on FiO2 100 %, on mechanical ventilator. CT scan Chest images (fig. 3) show air in the right ventricle and few specks of air in coronary vessels, consistent with air embolism

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Discussion

Conclusions