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

• Published in: Acute medicine & surgery Vol. 4; no. 2; pp. 213 - 216
• Main Authors: Yamaoka, Ayumu, Miyata, Kei, Narimatsu, Eichi, Sakawaki, Eiji, Sakawaki, Sonoko, Hirayama, Suguru, Uemura, Shuji, Yama, Naoya
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.04.2017; John Wiley and Sons Inc
• Subjects: Anesthesia; Bubbles; Case Report; Case Reports; Catheters; Cerebral air embolism; Contusions; Embolisms; Emphysema; Injuries; Intubation; Medical imaging; Patients; penetrating lung injury; positive pressure ventilation; Pulmonary arteries; pulmonary vein bronchial fistula; Stabbings; Thorax; Trauma; Veins & arteries; Ventilators; trauma; penetrating lung injury; positive pressure ventilation; Cerebral air embolism; pulmonary vein bronchial fistula
• ISSN: 2052-8817; 2052-8817
• DOI: 10.1002/ams2.250

Case A 44‐year‐old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation. Outcome Right hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course. Conclusion We concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered. In this case, a man who stabbed himself in the left thorax recieved positive pressure ventilation. Right hemiparesis appeared upon weaning from mechanical ventilation. DWI findings demonstrated characteristic laminar cortical hyperintense lesions in multiple lobes. Cerebral air embolism was strongly suspected from the imaging findings and clinical course.