Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction
Julio Lanfranco, Ivan Romero Legro, Amado X. Freire, Katherine Nearing, Sanjay Ratnakant
(Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA)
Am J Case Rep 2017; 18:80-84
Air embolism can occur in a number of medical-surgical situations. Venous air embolism is frequently lethal when a substantial amount enters the venous circulation rapidly and can lead to significant morbidity if crossover to the systemic arterial circulation occurs. The diagnosis of massive air embolism is usually made on clinical grounds by the development of abrupt hemodynamic compromise. The true incidence, morbidity, and mortality of this event is unknown given the difficulties in diagnosis.
CASE REPORT: An inadvertent antecubital venous injection of 150 mL of air using a contrast power injector during a computed tomography (CT) is reported. Immediate imaging (CT) showed a significant amount of air in the right atrium and right ventricular cavity, and air mixed with contrast in the main pulmonary artery and proximal divisions of the pulmonary circulation. Patient condition deteriorated requiring mechanical ventilation for 48 hours. Condition improved over the next few days and patient was successfully extubated and discharged home.
CONCLUSIONS: Air embolism is a rare complication, the potential for this to be life threatening makes prevention and early detection of this condition essential. This condition should be suspected when patients experience sudden onset respiratory distress and/or experience a neurological event in the setting of a known risk factor. Treatment options include Durant’s maneuver; left-lateral decubitus, head-down positioning; to decrease air entry into the right ventricle outflow tract, hyperbaric therapy, 100% O2 and supportive care.
Keywords: Anoxia, Embolism, Air, Hyperbaric Oxygenation