Cerebral Arterial Air Embolism after Diagnostic Flexible Fiberoptic Bronchoscopy: A Case Report and Review of the Literature

Abstract

Cerebral arterial air embolism (CAAE) is an extremely rare complication of diagnostic flexible fiberoptic bronchoscopy, reported to occur once about every 103978 examinations. In all the eight cases of CAAE reported previously, the patients had undergone transbronchial lung biopsy (TBLB) or transbronchial needle aspiration (TBNA) prior to the onset of CAAE. Herein, we describe the case of a 77-year-old patient with double primary lung cancer who developed CAAE after bronchial curette cytology, which is considered to be less invasive than TBLB or TBNA. The patient was treated with supplemental oxygen, but paresis of the left upper arm and left spatial neglect remained. This is the first report of CAAE occurring after bronchial curettage during diagnostic flexible fiberoptic bronchoscopy.

Cerebral Arterial Air Embolism After Endobronchial Electrocautery: A Case Report and Review of the Literature 

“…What they found was consistent with the fact that high ow of coolant gas can lead to vascular air embolism during the use of contact probe [10]. Other possible risk factors for CAAE include patients with chronic obstructive pulmonary disease, a cavity inside the mass, lesions in the upper lobe, left lateral position, semi-recumbent position and bleeding [1,7,18].…”

“…Hyperbaric oxygen therapy is recommended as the most bene cial treatment of CAAE [9,[16][17][18]20]. The mechanisms of hyperbaric oxygen therapy for CAAE include: reduced air volume, increased diffusion gradient out of the bubbles, reduction in cerebral edema, decreased endothelial damage, promotion of restoration of distal blood ow [3,6,16,20].…”

“…The mechanisms of hyperbaric oxygen therapy for CAAE include: reduced air volume, increased diffusion gradient out of the bubbles, reduction in cerebral edema, decreased endothelial damage, promotion of restoration of distal blood ow [3,6,16,20]. In some hospitals, HBO 2 is not available due to the lack of hyperbaric chamber or unable to transport patients [1,7,15,18]. The time to start HBO 2 treatment determines the outcome of the patients.…”

“…In conclusion HBO 2 should be initiated as soon as possible after the diagnosis of CAAE to reach the best effect. When there is no available of HBO 2 , normobaric oxygen (NBO 2 ) can be administered as the most frequent non-HBO 2 treatment [8,18].…”

Cerebral arterial air embolism after endobronchial electrocautery: a case report and review of the literature

“…In an animal study, Feller-Kopman et al [ 10 , 13 ] found that bronchoscopic thermal ablation with gas flow is associated with the occurrence of gas embolism in a dose-dependent manner, which is consistent with the fact that high flow of coolant gas can lead to vascular air embolism during the use of a contact probe [ 10 ]. Other possible risk factors for CAAE include patients with chronic obstructive pulmonary disease, a cavity inside the mass, lesions in the upper lobe, left lateral position, semi-recumbent position and bleeding [ 1 , 7 , 18 ]. In this case, the tumour was located in the posterior segment of the right upper lobe, completely obstructing the bronchus.…”