Enhancing vigilance for cerebral air embolism after pneumonectomy: a case report

Abstract

Background Vascular air embolism (VAE) is a rare but important complication that has not been paid enough attention to in the medical process such as surgery and anesthesia. Case presentation We report for the first time that a 54-year-old male patient with central lung cancer developed severe complications of CAE after right pneumonectomy. After targeted first-aid measures such as assisted breathing, mannitol dehydration and antibiotic treatment, the patient gradually improved. The patient became conscious at discharge after 25 days of treatment but left limb was left with nerve injury symptoms. Conclusion We analyzed the possible causes of CAE in this case, and the findings from this report would be highly useful as a reference to clinicians.

Cerebral Air Embolism After Pigtail Catheter Drainage for Pneumothorax: A Case Report and Review of the Literature

“…Cerebral air embolism is a rare but serious complication of pigtail catheter drainage, which can cause cerebral ischemia and hypoxia brain ( 6 ). Some patients recover smoothly without any neurologic complications ( 1 ), while a small number of patients have residual nerve injury symptoms ( 5 ) or even death ( 7 ). To the best of our knowledge, CAE occurring after the pigtail catheter insertion for drainage because of pleural effusion, which was initially reported by Kim SI in 2013 ( 1 ).…”

“…Second, gas is injected unintentionally into a vein in the chest wall or pleura when an anesthetic is injected, causing a CAE ( 1 ). Third, the air entering the pulmonary venous system exceeded the filtration capacity of the lungs, causing the air from the venous circulation to enter the arterial circulation and eventually form CAE ( 5 , 8 , 9 ). Fourth, when the gas enters the arterial circulation through an intrapulmonary arteriovenous fistula or cardiac shunt pathway ( 5 ).…”

“…Third, the air entering the pulmonary venous system exceeded the filtration capacity of the lungs, causing the air from the venous circulation to enter the arterial circulation and eventually form CAE ( 5 , 8 , 9 ). Fourth, when the gas enters the arterial circulation through an intrapulmonary arteriovenous fistula or cardiac shunt pathway ( 5 ). In our case, however, preoperative contrast-enhanced CT showed no intrapulmonary arteriovenous fistula, and cardiac color ultrasound showed no intracardiac defect, such as atrial septal defect and patent foramen ovale, so the cardiac shunt pathway was excluded.…”

“…The clinical symptoms of CAE largely depended on the quantity of gas and the areas of the brain that are affected ( 5 ). When the quantity of gas is less, patients may present with no clear clinical symptoms.…”

“…Cerebral air embolism (CAE) is an extremely rare but serious complication that has not been paid enough attention to in the medical invasive process such as percutaneous transthoracic lung biopsy ( 4 ), pigtail catheter drainage ( 1 ), and thoracic surgery ( 5 ). In this article, we report a case of a serious complication of CAE after pigtail catheter drainage and review the published literature.…”