Air Bubbles in the Heart: A Case of Contrast Media Injection-Induced Venous Air Embolism

Sohab Radwan,Scott Shepperd

doi:10.7759/cureus.8708

Abstract

Venous air embolism (VAE) is more frequently recognized nowadays with the increased use of computed tomography (CT). It may be detected during or even after intravenous contrast media injection. A wide range of clinical manifestations exist, ranging from an incidental finding in a clinically asymptomatic patient to obstructive shock and circulatory failure. Those found incidentally are usually small and have no significant effect on circulatory physiology. Larger air emboli, however, may be potentially fatal, and therefore it is important to recognize such a phenomenon in the setting of intravenous contrast media injection.

Highlights

Venous air embolism (VAE) during or after intravenous contrast media injection is being increasingly recognized with the more frequent use of computed tomography (CT) as a diagnostic modality in modern medicine [1]
Studies have shown that small volumes of air within the venous system are usually not detected clinically, but rather radiographically, as most patients are usually asymptomatic [1]
We hereby present a case of an incidental finding of a non-fatal VAE within the heart detected on CT following intravenous contrast media injection

Summary

Introduction

Venous air embolism (VAE) during or after intravenous contrast media injection is being increasingly recognized with the more frequent use of computed tomography (CT) as a diagnostic modality in modern medicine [1]. We hereby present a case of an incidental finding of a non-fatal VAE within the heart detected on CT following intravenous contrast media injection. A chest CT scan with intravenous contrast media was obtained. This involved injection of 85 ml of iodinated contrast (Iohexol) via the right upper extremity. A repeat chest CT scan without intravenous contrast, obtained 24 hours after the initial one, redemonstrated the same gas findings within the anterior nondependent parts of the right atrium, but slightly less in volume in comparison to the first study (Figure 4). A third chest CT scan without intravenous contrast, obtained four days later, demonstrated continued decrease with near complete resolution of the previously noted gas within the right atrium (Figure 5). It was favored that the visualized gas in the right atrium was secondary to forceful injection of intravenous contrast media

Discussion

Conclusions

Disclosures

Findings

Orebaugh SL