Case Of Air Embolism Research Articles

A Case of Air Embolism during Transoral Vestibular Endoscopic Thyroidectomy

Background: Carbon dioxide (CO2) embolism is a rare but potentially life-threatening complication of endoscopic surgery. While endoscopic thyroidectomy is superior to traditional open thyroidectomy in terms of cosmetic results, it may lead to venous or fatal paradoxical CO2 embolism. CO2 embolism involves the inadvertent injection of carbon dioxide into a large vein, artery, or solid organ. The clinical manifestations of CO2 embolism can vary from asymptomatic to neurological damage, cardiac failure, and even death, depending on the rate and volume of CO2 entry and the patient’s general condition. This case can enhance our understanding of CO2 embolization during endoscopic surgery. Case Presentation: This case report describes an incident in which a gas embolism occurred during endoscopic right lobe and isthmus thyroidectomy, resulting in arrhythmia and dramatic fluctuations in circulation and oxygen levels. The operation was halted, and CO2 injection was stopped. The surgical wound was covered with saline gauze, and the patient inhaled 100% pure oxygen while undergoing aggressive repeated manual pulmonary recruitment maneuvers. Additionally, vasoactive drugs such as m-hydroxyamine and ephedrine were administered to aid in treating the condition. The patient’s position was adjusted using the Durant maneuver (partial left lateral and Trendelenburg position). Following the aforementioned treatments, the patient’s ventricular arrhythmia transitioned back to a normal and regular sinus rhythm, and both circulation and oxygen levels stabilized. Conclusions: Carbon dioxide embolism is an uncommon yet potentially severe complication of laparoscopic procedures. We anticipate that this particular case will enhance our comprehension of carbon dioxide embolism during endoscopic surgery.

Computed Tomography-Guided Percutaneous Lung Biopsy Complicated by Symptomatic Systemic Air Embolism: Case Report and Review of the Literature

Computed tomography-guided percutaneous core needle biopsy of the lung is an undoubtedly useful and well-established interventional radiological procedure for the diagnosis of indeterminate pulmonary lesions. Complications of percutaneous core needle biopsy, such as pneumothorax and hemoptysis are considered mild and self-resolving, however systemic air embolism is considered a potentially fatal complication. Systemic air embolism occurs when the air enters a pulmonary vein secondary to a percutaneous CT-guided lung biopsy and is expelled into systemic circulation. Systemic air embolism is extremely rare: incidence of clinically apparent SAE is estimated at 0.061–0.17%, while clinically silent systemic air embolism may be as high as 3.8–4.8%. This study reports a case of air embolism in the cerebral arteries that resulted from a complex CT-guided percutaneous core needle biopsy of the lung. The present case highlights the main mechanisms of this pathology, risk factors, importance of complete thoracic CT after procedure, as well as management of rare complications.

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

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.

Treating ARDS-associated air embolism: a question of priorities

Gas embolism is a potential and often life-threatening complication of central venous catheters. We report a case of air embolism after tearing of the central catheter associated with severe acute respiratory distress syndrome. The severity of the clinical situation meant choices had to be made regarding the order of treatments. This clinical case provided useful eye-openers for patient management regarding the prioritization of treatments as well as the possibilities offered by hyperbaric oxygen therapy.

Another case of air embolism with placenta braevia

During the production of a combined turn in order to stop bleeding due to presentation of the child's seat at the very moment when the leg was captured, the pulse and respiration immediately stopped.

MASSIVE AIR EMBOLISM

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Air embolism is uncommon, but a potentially catastrophic medical emergency. Although minor cases of air embolism are asymptomatic and self-resolve, we present a case of a massive air embolism that caused the right ventricular failure and ultimately a cardiac arrest. CASE PRESENTATION: An 80-year-old female was brought to the emergency department(ED) with acute respiratory failure, after being found down at home. She was intubated in the field and mechanically ventilated. On arrival at the ED, she was hemodynamically stable. Laboratory workup was done and the patient was started on intravenous fluids and broad-spectrum antibiotics. She underwent a contrasted computed tomography (CT) of the chest and abdomen and was transferred to the intensive care unit(ICU). Soon after her arrival in the ICU, she went into a cardiac arrest. Cardiopulmonary resuscitation was performed with the successful return of spontaneous circulation. Her CT chest revealed a large air embolus in the right ventricle and pulmonary artery outflow tract, with additional scattered venous air emboli in the left brachiocephalic vein (Image 1). Intravenous fluids, inotropic support, hyperbaric oxygen were initiated and the patient was placed in the left lateral Trendelenburg position. The patient decompensated shortly and had another cardiac arrest and could not be revived. DISCUSSION: Air embolism can be arterial or venous depending on the cause. Surgery, trauma, intravascular catheters, and barotrauma such as from mechanical ventilation are common causes of air embolism. Arterial air emboli tend to cause microvascular occlusion in organs such as the brain and the heart. Smaller venous air emboli cause pulmonary microvascular occlusion and larger ones tend to obstruct pulmonary outflow tract mimicking cor pulmonale. Diagnosis is centered on high clinical suspicion and often aided by echocardiography to demonstrate intra-cardiac emboli or contrast-enhanced CT of the chest and/or pulmonary arteries to demonstrate emboli in the vasculature. In cases of large air embolism or hemodynamically unstable patients like ours, aggressive measures such as hyperbaric oxygen, mechanical ventilation, and intravenous fluids and vasopressors should be undertaken immediately. The patient should be moved to the left lateral decubitus head down position in cases of suspected venous air embolism and supine position in cases of suspected arterial air embolism. In some cases, air can be successfully aspirate from the right ventricle or pulmonary artery via a central venous catheter or pulmonary artery catheter with a limited benefit. CONCLUSIONS: This case highlights the importance of identifying an air embolism in a timely fashion as larger air emboli can be catastrophic. Prompt measures such as hyperbaric oxygen, patient positioning, and close hemodynamic monitoring should be initiated in cases of high clinical suspicion. Reference #1: Lowenstein E, Little JW 3rd, Lo HH. Prevention of cerebral embolization from flushing radial-artery cannulas. N Engl J Med 1971; 285:1414. Reference #2: Orebaugh SL. Venous air embolism: clinical and experimental considerations. Crit Care Med 1992; 20:1169. DISCLOSURES: No relevant relationships by Johnny Jaber, source=Web Response No relevant relationships by Saminder Kalra, source=Web Response No relevant relationships by Divya Patel, source=Web Response No relevant relationships by Raju Reddy, source=Web Response

A DREADED PROCEDURAL COMPLICATION DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Endoscopic retrograde cholangiopancreatography (ERCP) procedure has gained popularity and has become the method of choice for diagnostic and therapeutic modalities. But there is a concern about albeit concerns about the dreaded serious complications that can be a threat to the life of subjects. We, herein, report a case of air embolism. A 30-year-old lactating woman presented with nausea, vomiting, and epigastric pain for 2 weeks with deranged liver function tests. Computed tomography abdomen was suggestive of gallbladder calculus with the prominent common bile duct. She was electively posted for the ERCP procedure. During the course of procedure, untoward complication was encountered, and with transthoracic echocardiography and fluoroscopy, diagnosis of air embolism was more or less confirmed. In spite of our tremendous resuscitative maneuvers, the condition deteriorated and later succumbed to death.

Acute Early Graft Dysfunction Following Off Pump Coronary Surgery: A Case of Air Embolism

Acute Early Graft Dysfunction Following Off Pump Coronary Surgery: A Case of Air Embolism

A case of air embolism during lumbar surgery

A case of air embolism during lumbar surgery

A case of air embolism occurred during cervical spinal laminoplasty

A case of air embolism occurred during cervical spinal laminoplasty

An Ingestion of Industrial Strength Hydrogen Peroxide Resulting in Cerebral Embolism and Death

Hydrogen peroxide is a well-known remedy used in homeopathic medicine. Accidental ingestion can have a broad range of side effects depending upon the quantity and concentration of ingestion. Air emboli to the brain have been reported in very few case reports. We present an interesting case of accidental ingestion of 35% hydrogen peroxide resulted in ischemic stroke and seizures due to air embolism. Our patient was an elderly woman who accidentally drank industrial strength hydrogen peroxide thinking of water. Upon ingestion of approximately two tablespoons of hydrogen peroxide, she developed respiratory distress within few minutes. She was reported to have a frothy mouth and soon became unresponsive. EMS arrived and intubated her on her way to the hospital. A CT of the chest/abdomen/pelvis showed air in the heart, spleen, splenic and portal veins. A CT, MRI of head and EEG were performed to evaluate her altered mental status. She was treated with phenytoin, midazolam for seizure prophylaxis and hyperbaric oxygen for the air embolism without improvement. The family ultimately decided to transition to comfort measures only. This is a rare case of air embolism. About 20% of air-embolism occurs in contrast enhanced CT’s. Very rarely it can be because of hydrogen peroxide poisoning. Hydrogen peroxide has many common uses but has a great potential for misuse. Hyperbaric oxygen has a role in both limiting damage and enhancing recovery. This is the current standard of care as documented in previously reported case.

A case of air embolism caused by CT-guided marking of a small peripheral pulmonary nodule

A case of air embolism caused by CT-guided marking of a small peripheral pulmonary nodule

Case of fatal air embolism during double-J ureteral stent placement

Air embolism is a severe and fatal complication, but it is very rare during transurethral surgery. This report describes a case of air embolism during double-J ureteral stent placement in a 45-year-old woman. During ureteroscopy, a sudden decrease in oxygen saturation and end-expiratory carbon dioxide pressure and cyanosis of the face were observed. Subsequent echocardiography confirmed an air embolism by detecting bubbles in the heart. Despite resuscitative measures, the patient died rapidly. Detailed autopsy was performed to clarify the cause of death and the route of air entering into the circulatory system. The report presented here reminds urologists and pathologists that air embolism can occur during double-J ureteral stent placement and offers some suggestions regarding identification of air embolism at autopsy.

小型末梢肺癌に対するCTガイド下マーキングによる脳空気塞栓の1例

症例は73歳女性．胸部CTにて右肺S3に充実性陰影を伴うスリガラス陰影（mixed GGO）を認めた．4ヵ月間の経過観察で変化がなかったため，胸腔鏡下生検のため入院となった．手術直前にフックワイヤーを用いたCTガイド下マーキングを施行したところ，突然意識消失を来した．CTにて上行大動脈内と右大脳半球の脳溝に空気の存在を確認，まもなく左片麻痺と全身痙攣を発症，ただちに脳梗塞急性期の治療を行った．全身状態の落ち着いた4週間後に胸腔鏡下右肺部分切除術を施行．発症後8ヵ月の現在，左半身の脱力は残存している．稀に重篤な空気塞栓症が生じるため，フックワイヤーによるマーキングの適応については慎重に決定すべきである．

A suspected case of air embolism in endonasal surgery using CO2laser

A suspected case of air embolism in endonasal surgery using CO₂laser

A case of air embolism during endoscopic sphincterotomy

A case of air embolism during endoscopic sphincterotomy

Self‐Induced Fatal Air Embolism: Accidental Autoerotic Death or Suicide?

Autoeroticism comprises behavior deviations aimed at producing sexual gratification through the manipulation of one's own body. The use of asphyxia and the induction of pain (masochism) are well-known examples. "Atypical forms" of such behaviors have appeared in the literature as isolated cases. Fatal air embolism is most common in women (causing abortion), being very rare in men (urethral trauma). The authors present a probable case of air embolism associated with signs of autoeroticism, instrumented by the delivery of air through a system formed by a compressor (typical of those used in refrigerators), a syringe barrel, a segment of latex tubing (tourniquet), and a needle, which was found inserted into the glans penis of an adult male. The hypothesis of accidental death was chosen due to the findings at the scene. The body was decomposing when found, which hampered the conduction of examinations.

Air embolism during off-pump coronary artery bypass graft surgery -A case report-

There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO2 blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO2 blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass.

Systemic air embolism after transthoracic lung biopsy: A case report and review of literature

Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a very rare (0.07%) but potentially life-threatening complication. We report a fatal case of air embolism to the cerebral and coronary arteries confirmed by head and chest CT, followed by a review of the literature.

Fatal Massive Cerebral Air Embolism in a Lung Transplant Patient

Massive air embolism has been described in multiple clinical scenarios, especially in critical ill patients who undergo invasive procedures. Nevertheless, air embolism is often unrecognized and a high index of suspicion is required to diagnose this entity. Two previous cases of air embolism in lung transplant patients have been described in the literature; we describe a third case of fatal massive air embolism and cardiovascular collapse in a lung transplant patient. Case report. A 52-year-old woman who had a left lung transplant 18 months before admission presented with generalized convulsions and altered mental status. Forty-eight hours after admission and treatment of status epilepticus, she became severely hypotensive and her neurological status deteriorated to brain death. An electrocardiogram showed diffuse ST elevations and a non-contrast head computed tomography demonstrated intravascular air and cerebral edema. Inspection of her intravenous lines did not reveal any leakage or possible port of air entry. An autopsy did not reveal a source of air embolism. Although autopsy did not identify a source for air we suspect that the air originated from the transplanted lung. This case underscores the potential severe consequences of air embolism and its systemic manifestations. A high index of suspicion for cerebral air embolism is warranted in lung transplant patients who present with neurological symptoms.