Massive Systemic Air Embolism Research Articles

Treatment of massive systemic air embolism during lung biopsy

Percutaneous needle biopsy of lung lesions is commonly used and is usually regarded as a safe procedure with limited morbidity and extremely rare mortality. Most frequent complications are pneumothoax, pulmonary bleeding and hemoptysis. Other rare complications include systemic air embolus, tumor implantation and empyema. Systemic air emboli are extremely rare with a published incidence of 0.02' from a lung biopsy survey in the United Kingdom to 0.07' in the literature, but are serious and can be fatal. We present a case of massive air embolism occurring during lung biopsy and describe the technique used for immediate treatment.

Treatment of Massive Systemic Air Embolism During Lung Biopsy

AbstractPercutaneous needle biopsy of lung lesions is commonly used and is usually regarded as a safe procedure with limited morbidity and extremely rare mortality. Most frequent complications are pneumothoax, pulmonary bleeding and hemoptysis. Other rare complications include systemic air embolus, tumor implantation and empyema. Systemic air emboli are extremely rare with a published incidence of 0.02' from a lung biopsy survey in the United Kingdom to 0.07' in the literature, but are serious and can be fatal. We present a case of massive air embolism occurring during lung biopsy and describe the technique used for immediate treatment.

Massive Air Embolism After Lung Biopsy

A 69-year-old man presented with pneumogenic sepsis. A chest radiograph showed bilateral extensive infiltrates that did not respond to broad-spectrum antibiotic treatment. Progressive respiratory failure necessitated invasive mechanical ventilation (bilevel positive airway pressure, 0.5 inspiratory oxygen saturation; peak inspiratory pressure, 24 cm H2O; positive end-expiratory pressure, 8 cm H2O). Chest computed tomography (CT) revealed inflammatory infiltrates with caverns and bilateral pleural effusions. Blood and bronchoalveolar cultures remained sterile. Therefore, computed tomography-guided lung biopsy was performed with an 18-gauge core needle with the patient in prone position (Figure, A). A control computed tomography scan (Figure, B) revealed massive systemic air embolism. Shortly thereafter, the patient developed cardiorespiratory failure. Cardiopulmonary resuscitation remained unsuccessful. Figure. A , Computed tomography-guided lung biopsy of infiltrates was performed with an 18-gauge needle and the patient in prone position. B , Air embolism after lung biopsy involving intercostal arteries (arrow), coronary arteries (arrowheads), and the aorta (white asterisk). Percutaneous computed tomography-guided lung biopsy is a frequently performed procedure for histological and microbiological analyses of pulmonary …

Massive Systemic Air Embolism During Aortic Root Angiography

Air embolism (AE) is an uncommon but potentially catastrophic complication of angiography. Although coronary AE is a well-known complication of coronary angiography, which occurs in 0.27% of cases,1 incidence and consequences of systemic massive AE are largely unknown. However, case reports are important to discuss reasons, management, and consequences of this complication. A 46-year-old woman with uncontrolled hypertension, thoracic aortic aneurysm, and anginal episodes at rest was referred for coronary angiography. The procedure was uneventful until the aortic root angiogram, during which 40 mL of contrast agent was intended to be injected with 14 mL/s flow and a maximum pressure of 1200 psi. On injection of contrast media into aortic root, a massive influx of …

Massive Systemic Air Embolism during Extracorporeal Membrane Oxygenation Support of a Neonate with Acute Respiratory Distress Syndrome after Cardiac Surgery

Extracorporeal membrane oxygenation (ECMO) is universally accepted as a potential lifesaving therapy for neonates suffering severe cardiorespiratory failure, with survival reported as 81% weaning off ECMO and 69% to hospital discharge in this population. Although ECMO may reduce mortality in certain neonatal patients, it is associated with significant complications. Air in the circuit complicates 4.9% of neonatal ECMO runs, and it is crucial that all ECMO caregivers are trained in the prevention of air embolism and possess the knowledge necessary to efficiently identify and remove air from the ECMO circuit to prevent life threatening consequences. We present a fatal case of neonatal systemic air embolism leading to massive entrainment of air into the ECMO venous return cannula of a neonatal patient with acute respiratory distress syndrome following repair of obstructed total anomalous pulmonary venous connection. We describe the pathophysiology and presentation of this rare condition and the importance of early recognition, due to its high mortality rate.

Fatal Biliary-Systemic Air Embolism during Endoscopic Retrograde Cholangiopancreatography: A Case with Multifocal Liver Abscesses and Choledochoduodenostomy

We report a rare case of a massive fatal embolism that occurred in the middle of endoscopic retrograde cholangiopancreatography (ERCP) and retrospectively examine the significant causes of the event. The patient was a 50-year old female with an uncertain history of previous abdominal surgery for multiple biliary stones 20 years prior. The patient presented with acute right upper quadrant pain. An abdominal computed tomographic (CT) scan revealed the presence of multiple stones in the common bile duct (CBD) and intra-hepatic duct (IHD) with biliary obstruction, multifocal liver abscesses, and air-biliarygram. Emergency ERCP showed a wide and straight opening of choledochoduodenostomy, which may have been created during a previous surgery, and multiple filling defects in the CBD. With the use of a forward endoscope, mud stones were extracted through the opening of the choledochoduodenostomy. Cardiac arrest suddenly developed during the procedure, and despite immediate resuscitation, the patient died due to a massive systemic air embolism. We reviewed previously reported fatal cases and accessed factors facilitating air embolisms in this case.

Massive Systemic Air Embolism During Percutaneous Radiofrequency Ablation of a Primary Lung Tumor

We report the case of a systemic air embolism occurring during pulmonary radiofrequency ablation. At the end of the procedure, the patient experienced a sudden myocardial infarction, complicated by ventricular fibrillation, cardiac arrest, and cerebral infarction. Thoracic computed tomography showed an air-blood level inside the left atrium and ventricle, the aortic arch, and the coronary arteries. Cerebral computed tomography showed an infarct in the frontoparietal area. Myocardial infarction and stroke responded to resuscitation measures, including hyperbaric oxygenation. The occurrence of this life-threatening event confirms the need to train experienced anesthesiologists in these new invasive approaches to cancer treatment.

Massive systemic air embolism during off-pump coronary artery surgery

In OPCAB (off-pump coronary artery bypass) operations, development of cardiac arrest during the distal anastomosis to obtuse marginal coronary artery leads to significantly low blood pressure in the ascending aorta. Therefore, blowing of compressed air in high flow on not-slinged coronary artery may cause air mobilization from the coronary artery system into the ascending aorta that may result in severe brain damage.

Massive Systemic Air Embolism Treated with Hyperbaric Oxygen Therapy Following CT-guided Transthoracic Needle Biopsy of a Pulmonary Nodule

A rare complication of computed tomography (CT)-guided biopsies of pulmonary lesions is systemic air embolism, with hyperbaric oxygen therapy being considered the mainstay of therapy. The authors describe the case of a 47-year-old man with a left upper lobe mass invading the chest wall who underwent CT-guided needle biopsy of a right lung base nodule to evaluate for metastatic disease. This procedure was complicated by massive systemic air embolism confirmed by CT scan. After initial resuscitative measures, the patient received on-site hyperbaric oxygen therapy and demonstrated no residual clinical sequelae from this complication.

Bronchovenous fistula - leading to fatal massive systemic air embolism during cardiopulmonary bypass

We report a case of a bronchovenous fistula in an adult who could not be resuscitated following a mitral valve replacement. A 39-year-old man underwent a mitral valve replacement for severe mitral stenosis and regurgitation. Following uneventful valve replacement surgery, and while attempting to wean the patient off bypass, we encounted a bronchovenous fistula following mechanical ventilation. This patient could not be resuscitated following surgery because of persistent air embolism in the patient. Systemic air embolism has been reported to occur following penetrating chest injury. Especially, when the entry and the exit sites have been over sewn and either a marked Valsalva maneuver by the patient (such as coughing or straining) or forced positive pressure ventilation in excess of 60 torr occurs, systemic air embolism can be created from bronchiolar-alveolar to pulmonary venous fistula. It has also been described in blunt thoracic trauma. Bronchovenous fistula is occasionally encountered in neonates due to ventilation injuries with high ventilatory pressures, especially with underlying lung pathology like respiratory distress syndrome, necessitating such high ventilatory pressures. To our knowledge, this is the first such case reported in the literature.

Massive Systemic Air Embolism Following a Blunt Chest Injury

Massive Systemic Air Embolism Following a Blunt Chest Injury