Arterial air embolism

Durant, Thomas M.; Oppenheimer, M. J.; Webster, Margaret; Long, Joan

doi:10.1016/0002-8703(49)90001-0

Cited by 75 publications

(35 citation statements)

References 23 publications

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“…Pulmonary vessel filtration protects the systemic and coronary circulation from AE orginating in the venous circulation [263]. When air bubbles are finally trapped in the pulmonary capillaries, the pulmonary arterial pressure increases, and the increased resistance to right ventricular outflow diminishes pulmonary venous return resulting in diminished cardiac output [264]. When .50 mL of gas is injected abruptly into human veins, acute cor pulmonale, asystoly or both can occur [265].…”

Section: Pathophysiologymentioning

confidence: 99%

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Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Pathophysiologymentioning

confidence: 99%

“…Detection of air in retinal vessels and the occurrence of sharply-defined areas of pallor on the tongue have been described. Marbling of the skin may occur and is especially noted in superiorly located body parts because the distribution of air is determined by the principle of air buoyancy [264].…”

Section: Clinical Signsmentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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“…Doses of air were injected into the coronary arteries of dogs, with volumes as low as 0.025 mL causing myocardial ischemia. 9,10 The size and location of the bubbles are the principal factors of potential damage to tissue. For example, in dogs, intravenous air injections totaling one liter were tolerated and filtered/ trapped within the lungs, thus, protecting arterial vessels.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the potential risks of bubble studies during echocardiography

Bassett

Tran

et al. 2014

Perfusion

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“…Further evidence that makes the clinical diagnosis of cerebral air emboli beyond much doubt is the presence of localized skin marbling and focal livedo reticularis. This unusual dermal feature represents venodilation in response to arteriolar occlusion and is considered a definitive clinical sign of gas embolism [5,8]. Cerebral air embolism may occur following diving accidents [9], neonatal respiratory distress syndrome [10], cardiovascular surgery, neurosurgery and central line placement [11].…”

Section: Discussionmentioning

confidence: 99%

Cerebral air embolism complicating bilevel positive airway pressure therapy

Hung

1998

Eur Respir J

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Most forms of barotrauma including pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, pneumoperitonium and subcutaneous emphysema commonly occur in both adult and paediatric patients placed on mechanical ventilation. However, barotrauma is considered to be rare in patients receiving noninvasive positive pressure ventilation (NPPV) as bilevel positive airway pressure (BiPAP) ventilation. In this report, an unusual case is presented of pulmonary barotrauma in a 13 yr old leukaemic patient with post-transplant pneumonitis who developed pulmonary barotrauma and possibly cerebral air embolism while being noninvasively ventilated with BiPAP. Case reportA previously well 13 yr old male was admitted to our hospital in February 1997 because of a one-month history of pallor, fatigue and febrile episodes. Physical examinations showed splenomegaly and purpura over the lower limbs. The blood biochemistries were within normal ranges. The complete blood count revealed a haematocrit of 16.0%, a white blood count of 21.9×10 9 cells·L -1 with 74% lymphoblasts and a platelet count of 29×10 9 cells·L -1 . Haematological malignancies were highly suspected and a bone marrow aspiration was performed. Microscopic examination of the bone marrow aspirate revealed >90% of lymphoblasts. A diagnosis of acute lymphoblastic leukaemia was established.Chemotherapy with vincristine, prednisolone, daunorubicin, and asparaginase was started. The patient's postchemotherapy course was complicated by acute pancreatitis and hyperglycaemia. Because complete remission was not achieved after induction chemotherapy, the regimen was switched to cytosine arabinoside for 7 days and daunorubicin for 3 days (A7D3) and additional cytosine arabinoside for 5 days and idarubicin for 2 days (A512). Repeated bone marrow examination, however, still showed excessive lymphoblasts. On April 15, cytosine arabinoside and novantrone were administered. High-dose methotrexate chemotherapy was performed on April 29 because of refractory leukaemia. On May 5, he began to receive buffy coat transfusion from his father, but the response was poor. He then agreed to have an allogeneic transplantation.The patient underwent allogeneic peripheral blood stem cell transplantation (PBSCT) on May 22 following conditioning with cyclophosphamide and total body irradiation. On day 10 after transplantation, a grade III acute graft versus host disease developed but resolved after immunosuppressive therapy. He was treated with broad-spectrum antibiotics and frequent blood transfusions for his prolonged pancytopenia and fever. Prophylactic gancyclovir against cytomegalovirus (CMV) was also given. His condition stabilized. On July 20, 58 days post-transplant, progressive dyspnoea developed. A chest radiograph showed diffuse interstitial pulmonary infiltrates. Sputum cultures yielded normal mixed flora and multiple blood cultures grew no micro-organisms. Further invasive studies were not performed because of the patient's reluctance. Combinations of high-dose steroids, i.v. trimeth...

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Arterial air embolism

Cited by 75 publications

References 23 publications

Nonthrombotic pulmonary embolism

Nonthrombotic pulmonary embolism

Evaluating the potential risks of bubble studies during echocardiography

Cerebral air embolism complicating bilevel positive airway pressure therapy

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