Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy:A case report

BACKGROUND Computed tomography(CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology,but entails a risk of complications including systematic air embolism(SAE).While SAE is often well tolerated,it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARY We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe.Shortly following needle extraction,she experienced a mild cough,hemoptysis,rapid-onset unconsciousness,and cardiopulmonary arrest.Cardiopulmonary resuscitation was immediately performed,but the patient died 40 min after the procedure.A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSION Although SAE is generally well tolerated and asymptomatic,interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols.In this report,the characteristics,mechanisms,and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.

Suspected cerebrovascular air embolism during endoscopic esophageal varices ligation under sedation with fatal outcome: A case report

BACKGROUND Air embolism is a very rare,yet serious and potentially fatal complication of digestive endoscopic treatment.Air embolism is the result of air directly entering the arteries or veins.However,to recognize neurological dysfunction under sedation can be difficult.Therefore,it is extremely important to identify high-risk groups and take preventive measures.CASE SUMMARY Herein,we report a 74-year-old female patient with esophageal varices who suffered from consciousness disturbance after the third endoscopic ligation of esophageal varices under sedation.Combined with the patient’s imaging examination results and medical history,we highly suspected that the patient had developed paradoxical cerebral air embolism during endoscopic ligation.We learned that the patient died at a later follow-up.In order to be able to identify and prevent the occurrence of air embolism early,we summarize and analyze the risk factors,pathogenesis,clinical manifestations,prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism.CONCLUSION Electroencephalographic monitoring helps to recognize the occurrence of air embolism in time and increase the patient's chance of survival.

Cerebral air embolism complicating transbronchial lung biopsy: A case report

BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.

TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery

A 36-year-old woman suffered meningioma in her right cerebellopontine angle.Air embolisms often complicate sitting-position surgeries.Because TEE guides the localization of central venous catheters and promptly locates air embolisms promptly enough for effective treatment,TEE is an effective monitoring method for sitting-position surgeries.

Systemic air embolism complicating upper gastrointestinal endoscopy:a case report with post-mortem CT scan findings and review of literature

Endoscopy of the gastrointestinal and biliary tract is a common procedure and is routinely performed for therapeutic and diagnostic purposes.Perforation,bleeding and infection are some of the more common reported side effects.Air embolism on the other hand,is a rare complication of gastrointestinal endoscopy.We report a 77-year-old African-American female with a history of pancreatic cancer,which was resected with a Whipple procedure.As part of diagnostic and therapeutic procedure,an endoscopic retrograde cholangiopancreatography was planned several months after the surgery.The patient’s heart rate suddenly slowed to 40 bpm during the procedure and she became cyanotic and difficult to oxygenate after the endoscope was introduced and CO2 gas was insufflated.A forensic autopsy was performed with post-mortem computed tomography(PMCT)and revealed extensive systemic air embolism.The detailed PMCT and autopsy findings are presented and current literature is reviewed.

Case of Fatal Air Embolism during Double‑J Ureteral Stent Placement

Air embolism is a severe and fatal complication,but it is very rare during transurethral surgery.This report describes a case of air embolism during double‑J ureteral stent placement in a 45‑year‑old woman.During ureteroscopy,a sudden decrease in oxygen saturation and end‑expiratory carbon dioxide pressure and cyanosis of the face were observed.Subsequent echocardiography confirmed an air embolism by detecting bubbles in the heart.Despite resuscitative measures,the patient died rapidly.Detailed autopsy was performed to clarify the cause of death and the route of air entering into the circulatory system.The report presented here reminds urologists and pathologists that air embolism can occur during double‑J ureteral stent placement and offers some suggestions regarding identification of air embolism at autopsy.

A fatal case of oxygen embolism in a hospital

This case reports on a 68-year-old man who was found dead in hospital next to his bed.Before this,he had been treated with intravenous antibiotics for pneumonia.The body was found with a peripheral venous catheter connected to a nasal cannula delivering oxygen(O_(2))from the wall.Extensive medico-legal examinations were performed,including post-mortem computed tomography(CT),complete conventional autopsy,histological and immunohistochemistry analysis,toxicological analysis and post-mortem chemistry.Additionally,CT-guided gas sampling was performed at multiple sites to collect samples for gas analysis.During the external examination,massive subcutaneous emphysema was visible over the entire surface of the body.The CT scan revealed the presence of gas throughout the vascular system,and in the subcutaneous and muscular tissues.The autopsy confirmed the presence of lobar pneumonia and multiple gas bubbles in the vascular system.The gas analysis results showed a subnormal concentration of oxygen,confirming the suspected pure O_(2) embolism.Moreover,the carbon dioxide(CO_(2))concentration in the gas sample from the heart was elevated to a level similar to those found in scuba diving fatalities.This could come from degassing of dissolved CO_(2) that accumulated and was trapped in the cardiac cavity.Based on the results of the different exams performed,and especially the gas analysis results,it was concluded that the cause of death was O_(2) embolism.

Laparoscopic left hemihepatectomy under occlusion of the left inflow and outflow

Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepatectomy, except for resection of the peripheral liver or left lateral segment when porta hepatis dissection is not indicated. Although both inflow and outflow control seems to be ideal in laparoscopic left hepatectomy, there have not been many reports of this. In addition to the high technical demands and the time required, any injury of the main hepatic veins or vena cava during the procedure will cause catastrophic bleeding and air embolism. Recently, we succeeded in achieving inflow and outflow occlusion during laparoscopic left hemihepatectomy in four cases, with satisfactory results.

Evaluation of Hysteroscopic-guided Removal of Intrauterine Device in Shanghai: A Report of Four Dead Cases

Objective To analyze the possible cause leading to death during the procecture oy IUD removal under hysteroscopy and how it could be prevented. Methods All （11 110） cases of IUD removal under hysteroscopy performed at 87 hospitals in Shanghai from 2001 to 2007 were reviewed. Four dead cases were reported. Results Air embolism was suspected as the cause of death. Associated risk factors included insufficient preoperative preparation, short duration between surgeries, non-standard procedure, careless observation and untimely resuscitation. Conclusion This emphasizes the necessity of early interventions taken such as prevention, early detection and management of the fatal complications.