Cerebral air embolism associated with penetrating lung injury: a case report and review of the literature

Abstract

CaseA 44‐year‐old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation.OutcomeRight hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course.ConclusionWe concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered.

Successful Video-Assisted Thoracoscopic Removal of a Chest Tube Protruding Deep Into the Pulmonary Hilum

“…Systematic air embolism (SAE) is a rare but lethal complication of lung injuries. The pulmonary vein and airways are simultaneously damaged, inducing air entrapment in the injured pulmonary vein [ 10 ]. The presence of air shunting, pneumothorax, lung contusions, and positive pressure ventilation can be risk factors for SAE, as there is a continuous flow of air in the vicinity of the systemic arterial circulation [ 11 ].…”

“…Positive pressure ventilation could be a trigger for late-onset SAE. Therefore, one-lung ventilation during general anesthesia is recommended [ 10 ]. In cases of sudden hemodynamic instability and neurological symptoms in patients with lung injury on mechanical ventilation, SAE should be suspected.…”