Chronological Changes in Cerebral Air Embolism That Occurred during Continuous Drainage of Infected Lung Bullae

Abstract

We present a 43-year-old man with cerebral air embolism that occurred during continuous drainage of infected lung bullae. This complication is extremely rare, and may have been caused by the passage of air into the pulmonary venous circulation through a bronchovenous fistula and/or damaged pulmonary vessels. Air densities were demonstrated along the right frontal gyri on a CT performed 1 h after the onset of embolism, then moved to the deep cortex after 2.5 h. Three days later, a cortical infarct accompanied with extensive white matter edema in the right frontal lobe was confirmed by MRI. These CT and MRI findings may indicate the passage of intravascular air from the superficial to the deep cortex and subsequent cerebral infarction.

Infected Giant Bulla Treated by Percutaneous Drainage Followed Later by Resection: Report of a Case

“…This patient suffered from air embolism triggered by coughing. 4 Other complications were slight air leakage in fi ve patients (including our patient) and localized empyema in one patient.…”

“…Thus, when antibiotics are ineffective against an infected bulla, percutaneous therapy with or without subsequent surgery may be the treatment of choice. 7 ND 9 56 days Improved Slight leakage Kirschner et al 2 8.5 Fr >17 1 day Improved -Kaneki et al 8 6 Fr 26 5 days Disappeared -Yanase et al 9 14 G 90 26 days Improved -Takizawa et al 4 ND ND ND ND Air embolism Hoshino et al 10 16 G 19 ND Improved -Matsuno et al 11 ND 21 14 days Improved -Goto et al 12 ND 7 6 days Improved -Ozaki et al 13 8 …”

Percutaneous transhepatic drainage of lung abscess through a diaphragmatic fistula caused by a penetrating liver abscess

“…In addition, transpulmonary puncture carries the potential risk of causing systemic air embolism, as is the case with lung biopsy. 6,7 We think a percutaneous transhepatic approach through the diaphragmatic fi stula, which has not been previously reported, has the advantage to avoid these risks of the transpulmonary approach for treating such cases.…”

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

“…The definitive diagnosis of CAE might be difficult to confirm in the acute phase, because the air shadow in the vessels of the brain in the CT examination can disappear in 0.5-30 h. 9 Especially in trauma, the air shadow often disappears during the initial resuscitation treatment, imaging tests, surgery, and ventilator management. 4,7 Therefore, CAE could be suspected as a diagnosis of exclusion in the absence of intravascular air shadows.…”