Iatrogenic Air Embolism Research Articles

Middle cerebral artery hypodense dot sign in iatrogenic air embolism.

Air embolism is a rare cause of stroke, usually associated with medical procedures, with gastrointestinal endoscopy rarely implicated. Here, we present a case of a patient who experienced cerebral air embolism post-gastroscopy, presenting with aphasia and right hemiparesis due to left M2 occlusion with spontaneous and complete recovery. CT scan revealed a hypodense defect in the left Sylvian fissure, representing a "hypodense dot sign" suggestive of an air embolism. The hypodense MCA sign, previously described in fat embolism cases, could also indicate air embolism, supporting prompt diagnosis and proper intervention.

Iatrogenic Air Embolism with Middle Cerebral Artery Stroke Following Lung Biopsy (P8-5.018)

Iatrogenic Air Embolism with Middle Cerebral Artery Stroke Following Lung Biopsy (P8-5.018)

Iatrogenic gas embolism in a juvenile loggerhead sea turtle (Caretta caretta)

A mild pneumocoelom was diagnosed by computed tomography in a stranded juvenile loggerhead sea turtle (Caretta caretta). After gas extraction by ultrasound-guided puncture, the animal did not improve and was subjected to hyperbaric oxygen therapy (HBOT). After HBOT, the turtle developed marked subcutaneous emphysema and was found dead the following morning. Gross lesions included a distended right atrium with numerous gas bubbles within the epicardium, gas bubbles in the hepatic, gastric and mesenteric veins, a small gas-filled bulla in the left lung and diffuse haemorrhages in the encephalon. Histological lesions included gas-like emboli in the lumen of the right atrium with myocardial necrosis, gas-like emboli in the lumina of intestinal, pulmonary and renal blood vessels and severe meningeal haemorrhages. From a forensic pathology perspective, the subcutaneous emphysema of immediate onset after HBOT and the greater severity of the histological lesions in blood vessels, heart, lung and brain differentiate this case from other cases of gas embolism in turtles due to incidental capture. Two factors contributed to this outcome: the existence of a probably unresolved pneumocoelom and the application of HBOT without an initial diagnosis that accurately indicated its use. Therefore, as in human medicine, the use of HBOT in sea turtles with lung lesions and pneumocoelom is discouraged. This is the first description of an iatrogenic gas embolism in a sea turtle.

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies.

Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.

Iatrogenic air embolism: influence of air bubble size on cerebral infarctions in an experimental in vivo and numerical simulation model

BackgroundCerebral infarctions resulting from iatrogenic air embolism (AE), mainly caused by small air bubbles, are a well-known and often overlooked event in endovascular interventions. Despite their significance, the underlying pathophysiology...

Iatrogenic gas embolism

Iatrogenic gas embolism

Iatrogenic Venous Air Embolism (VAE) in a patient secondary to contrast injection; a rare case

Venous Air Embolism (VAE) can occur in patients while injecting contrast material, we have reported a case of a 26 yrs old patient who came with the complaint of abdominal pain, vomiting, and fever with no known Co-morbid. CT whole abdomen with contrast was performed and the patient was injected with contrast, which resulted in an air embolism. On administration of contrast, air is seen in the hepatic vein which was not seen on plain and delayed images. 93 ml of contrast material was intravenously injected by hand and followed by a drip infusion of 100 ml of contrast material.

Bronchoscopy-Associated Cerebral Arterial Air Embolism Presenting with Acute Ischemic Stroke and Status Epilepticus (P12-5.013)

<h3>Objective:</h3> To describe a rare cause of iatrogenic air embolism, causing acute ischemic stroke complicated by status epilepticus. <h3>Background:</h3> The incidence of vascular air embolism during bronchoscopy is estimated to be 2.65 per 100,000 hospitalizations, with 30% of these involving endovascular procedures. A recent case report and literature review identified only 5 cases of cerebral arterial air embolism following bronchoscopy. A small minority of acute ischemic strokes present with seizures, even fewer with status epilepticus. <h3>Design/Methods:</h3> NA <h3>Results:</h3> An 81-year-old woman with past medical history significant for hypertension and CREST syndrome presented to an outside hospital for elective bronchoscopy with biopsy of pulmonary nodules. Post-procedurally, she was noted to have new left-sided hemiparesis. Non-contrast CT head demonstrated a small arterial air embolism in the right frontal lobe. She was brought to the Emergency Department and sustained a bilateral tonic-clonic seizure lasting 30 seconds, resolving with intravenous lorazepam. Prior to returning to her mental status baseline, she had recurrent seizure activity, refractory to benzodiazepines, requiring an intravenous phenytoin load, intubation for airway protection, and sedation with propofol. She was transferred to our institution’s neurocritical care unit where repeat CT head exhibited sulcal effacement and she was treated with hypertonic saline for cerebral edema. Continuous EEG did not reveal any epileptiform patterns but the patient was started on levetiracetam for her acute symptomatic seizures. MRI later revealed small infarcts in multiple vascular territories. She was ultimately extubated and at the time of discharge to short-term rehabilitation, her only deficit was 4+/5 strength throughout the left arm, which normalized by 1-month follow-up. She was eventually weaned off of levetiracetam in the outpatient setting. <h3>Conclusions:</h3> This case adds to our understanding of this rare procedural complication and, given the complications of her stroke by status epilepticus and cerebral edema, highlights the potential severity of these injuries. <b>Disclosure:</b> Dr. Sutherland has received personal compensation in the range of $0-$499 for serving as a Consultant for McGraw-Hill. Dr. Gummerson has nothing to disclose. Dr. Sharma has nothing to disclose.

SOPHISTICATED AIR HEAD: A UNIQUE PRESENTATION OF IATROGENIC AIR EMBOLISM IN SOFT TISSUE OF THE NECK AND CHEEK

SOPHISTICATED AIR HEAD: A UNIQUE PRESENTATION OF IATROGENIC AIR EMBOLISM IN SOFT TISSUE OF THE NECK AND CHEEK

THERAPEUTIC MANUAL ASPIRATION OF LARGE VENOUS AIR EMBOLISM IN A PATIENT WITH SHOCK

THERAPEUTIC MANUAL ASPIRATION OF LARGE VENOUS AIR EMBOLISM IN A PATIENT WITH SHOCK

A witnessed intra-operative blood transfusion-related air embolism under epidural anaesthesia for vesicovaginal fistula repair

The transfusion is a normal life-saving procedure conducted commonly by the nurses at the prescription of the attending physician or the emergency physicians. It is generally a safe procedure if guidelines for processing and administering are carefully followed. Blood transfusion is an independent risk factor for morbidity and mortality and major complications arising from transfusion are generally rare. We present a case of a mild case of iatrogenic air embolism exacerbated by pressure infusion for a patient who had undergone an exploratory laparotomy for an iatrogenic fistula repair under epidural anesthesia.

Massive Cerebral Air Embolism Due to Aortography

Though rare, air embolism as a serious complication may occur in patients undergoing coronary angiography and aortography. If gas embolism is diagnosed, hyperbaric oxygen therapy should be initiated immediately after the air source is cutoff and vital functions are stabilized. In this case presentation, a patient went into a coma after a massive iatrogenic cerebral air embolism that developed during the aortography procedure. The patient was discharged with hyperbaric oxygen therapy without any sequelae.

64 Dedektörlü Bilgisayarlı Tomografide Kontrast Madde Enjeksiyonu Sonrası Nonfatal Venöz Hava Embolisi Sıklığı ve Lokalizasyonu

During diagnostic and interventional radiological procedures, venous air embolism is seen as a nonfatal event. In this study, it was aimed to determine the frequency and localization of nonfatal venous air embolism in contrast enhanced computed tomography (CT). 1654 contrast-enhanced thorax computed tomography examinations performed in the Radiology Unit of our hospital between January 1, 2019 and December 31, 2019. The localization and size of the detected venous air emboli and from which side the contrast agent was administered were recorded. In this study, iatrogenic venous air embolism was seen in 3.1%. The most common localization is the main pulmonary artery (1.81%) and other localizations in order of frequency are left brachiocephalic vein (0.66%), left subclavian vein (0.36%), right brachiocephalic vein (0.30%), right subclavian vein (0.24%), right ventricle ( 0.18%) and right atrium (0.18%). Looking at the size of the venous air embolism, 2.5% small, 0.50% moderate and 0.12% large air embolism were seen. Radiologists should be aware of the possibility of vascular air embolism after contrast agent injection in CT scanning and should be careful.

MASSIVE AIR PULMONARY EMBOLISM: IS IT REAL?

SESSION TITLE: Fellows Pulmonary Vascular Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Air embolism is a rare but potentially catastrophic condition that occurs when air enters into the vasculature. Here we present a case of venous- air-embolism causing hemodynamic compromise that was treated with hyperbaric oxygen. CASE PRESENTATION: 63 years old female with COPD on LTOT presented at an outside hospital with worsening shortness of breath, found to be in hypercarbic respiratory failure presumable from acute exacerbation of COPD. Peripheral iv lines were placed, she was given fluids and placed on antibiotics, nebulizers and steroids. Patient rapidly deteriorated into refractory shock requiring pressors and hypoxia needing endotracheal intubation. Patient was also noted to have a seizure while in the ED. On transfer to our hospital, patient continued to remain in refractory shock and refractory hypoxia with PaO2/FiO2 ratio of 150. CXR showed changes consistent with obstructive lung disease. CT scan of chest was performed given unexplained hypoxia and shock which showed evidence of air in the main pulmonary artery extending into the segmental and subsegmental arteries with air also tracking from left subclavian vein into SVC. CT scan of head was unremarkable. Diagnosis of venous air embolism was made, and patient was placed in left lateral decubitus, Trendelenburg position with 100% FiO2 on the ventilator. Decision was made to proceed with hyperbaric oxygen therapy (HBO) due to severe hemodynamic instability. ENT was consulted for bilateral myringotomies prior to the therapy. Patient successfully received hyperbaric oxygen therapy for almost 7 hours, with complete resolution of air embolism on repeat CT scan of chest. Patient came off of vasopressors immediately after completion of treatment. She was extubated on day 4 of mechanical ventilation. DISCUSSION: Air embolism is a rare but potentially catastrophic condition that occurs when the air enters into the vasculature. It can be venous and arterial. Common causes include vascular intervention, surgery, trauma, barotrauma from mechanical ventilation and diving. Diagnosis require high clinical suspicion and imaging evidence. Treatment options are limited including positioning, HBO and direct removal of air. Venous embolisms are self-limiting if volume of air is <50 ml, beyond which patients can have direct and indirect effect of embolism. Based on indications different treatment tables are used for HBO therapy. It was thought that our patient had iatrogenic air embolism from IV access placed on the left arm. She was appropriately started on HBO as she was hemodynamically unstable. There is limited literature about direct removal of air using catheters and it is typically performed when catheters are already in place. CONCLUSIONS: Air embolism, especially pulmonary air embolism, is life threatening and prompt intervention with appropriate positioning and HBO are life saving measures. Reference #1: King, Melissa B., and Keith R. Harmon. “Unusual forms of pulmonary embolism.” Clinics in chest medicine 15.3 (1994): 561-580. Reference #2: Leach, R. M., P. J. Rees, and P. Wilmshurst. “Hyperbaric oxygen therapy.” Bmj 317.7166 (1998): 1140-1143. Reference #3: Bessereau, Jacques, et al. “Long-term outcome of iatrogenic gas embolism.” Intensive care medicine 36.7 (2010): 1180-1187. DISCLOSURES: No relevant relationships by Hassan Yousaf, source=Web Response

Suspected venous air embolism during thoracic limb amputation in a dog

A six-year-old dog was anaesthetised for the amputation of her left forequarter. Preoperative haematology, biochemistry and physical examination were unremarkable. Twenty minutes into surgery, a sudden decrease in end tidal...

Transthoracic echocardiography-monitored CO2-insufflation esophageal endoscopy for diagnosis of Atrioesophageal fistula and prevention of iatrogenic air embolism: a case report

BackgroundAtrioesophageal fistula (AEF) is the most fatal complication associated with catheter ablation for atrial fibrillation and cannot be easily detected when thoracic contrast-enhanced computed tomography (CT) is normal.Case presentationIn this report, we described a diagnostic tool for detecting AEF with doubtful chest CT in which we introduced CO2-insufflation esophageal endoscopy with transthoracic echocardiography monitoring. Using this modified esophageal endoscopy, AEF was established due to the presence of both esophageal lesions and bubbles into the left atrium. That way, our patient accepted to be operated in time with good clinical prognosis.ConclusionsThis modified esophageal endoscopy is an alternative tool for early detection of AEF when normal or doubtful CT findings present.

Pulmonary Air embolism Associated with Pneumocephalus: A Case Report

Iatrogenic air embolism is associated with significant morbidity and mortality. Retrograde cerebral venous air embolism is most frequently associated with manipulation of venous access most commonly from central venous catheters. The ascension of air to the cerebral circulation is possibly due to the low specific gravity of air compared to blood and the performance of procedures in the sitting position. Increased right ventricular pressures in the setting of pulmonary thromboembolism may also contribute to the retrograde flow of air. We present the case of a 61-year-old woman who developed a massive pulmonary embolism and pneumocephalus, which was evident during contrast enhanced CT pulmonary angiography. Neurological deficits were not apparent and air resorption occurred after 48 hours of high flow oxygen therapy.

Iatrogenic Air Embolism- Air Embolism during Pacemaker Implantation

Iatrogenic Air Embolism- Air Embolism during Pacemaker Implantation

Development of a Porcine Model of Coronary Stenosis Using Fully Percutaneous Techniques Suitable For Performing Cardiac Computed Tomography, CT-Perfusion Imaging and Fractional Flow Reserve

The aim of this study was to develop and describe percutaneous coronary angiographic techniques to create a porcine model of acute coronary stenosis with methacrylate plugs that can by assessed using fractional flow reserve (FFR), invasive coronary angiography and coronary computed tomographic (CT) perfusion imaging without introducing artefacts associated with surgical models. Following animal care and institutional approval and using percutaneous coronary catheterisation techniques within an animal laboratory we introduced precision drilled methacrylate plugs into one of the three main coronary arteries of 10 experimental female pigs. Coronary pressure wire measurements were performed across the experimental stenosis for the calculation of FFR. Invasive coronary angiograms were obtained in stenosed arteries. Animals were transported to a dual source CT scanner (Siemens Healthcare, Forcheim, Germany) and CT perfusion imaging was performed. Ten (10) pigs were investigated with seven data sets obtained. Three (3) pigs expired prior to CT imaging secondary to pneumothorax, high grade coronary stenosis with induced cardiac arrhythmia and iatrogenic air embolism. Graded coronary stenosis was produced in six pigs in the LAD (2), LCX (2) and RCA (2) territories and one animal served as a control. Fractional flow reserve ranged from 0.21 to 0.91. Myocardial blood flow derived from dynamic CT perfusion imaging ranged from 3.5 to 136.7ml/100ml of tissue/minute. No artefacts from the deployment of the methacrylate plug, nor the plug itself, were identified. Fully percutaneous preparation of a pig model of acute coronary stenosis is feasible and provides subjects for imaging that are free of surgically induced artefact. This technique is substantially less expensive than surgically induced coronary stenosis and can be performed using standard catheterisation techniques with mobile imaging equipment. The technique is extendable to produce multivessel acute coronary stenosis and can be used for multimodality imaging.

Safety of hyperbaric oxygen therapy in mechanically ventilated patients.

To evaluate the epidemiology of patients who require mechanical ventilation during hyperbaric oxygen therapy. One-hundred-fifty patients who required mechanical ventilation during hyperbaric oxygen therapy were prospectively studied during a 6-year period in a French university hyperbaric centre. We analysed the indication of hyperbaric oxygen therapy, agent used for sedation, presence of a chest tube, need for vasopressor agents and tolerance and appearance of side effects. Finally, we compared the outcomes of patients according to the presence or absence of acute respiratory distress syndrome (ARDS). Eleven children and 139 adult patients were included (n = 150) in the study. In both populations, carbon monoxide poisoning (51%) and iatrogenic gas embolism (33%) were the two main causes of intubation and mechanical ventilation. The combination of midazolam and sufentanil was used in 85 (67%) patients. All of the patients were given a bolus of a neuromuscular blocker during the hyperbaric session, despite the presence of ARDS in 35 patients. Patient-ventilator asynchrony was the most frequent side effect in 6 (5%) patients and was often the consequence of suboptimal sedation. Mortality was higher in the group with ARDS (23%). Carbon monoxide poisoning and iatrogenic gas embolism are the two main diseases of the patients who required mechanical ventilation during hyperbaric oxygen therapy in this study. Mechanical ventilation is a safe method for patients during hyperbaric oxygen therapy. Sedation needs to be perfected to avoid patient-ventilator asynchrony.