Ventilation-induced massive lethal air embolism and subcutaneous emphysema in a patient with a lung cavern

• Published in: Respiratory care Vol. 60; no. 1; pp. e6 - e10
• Main Authors: Verelst, Wim, Verbrugghe, Walter, Lammens, Martin, Snoeckx, Annemie, Jorens, Philippe G
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01.01.2015
• Subjects: Aged; Artificial respiration; Carcinoma, Non-Small-Cell Lung - complications; Care and treatment; Case studies; Causes of; Complications and side effects; Embolism; Embolism, Air - etiology; Emphysema, Pulmonary; Fatal Outcome; Female; Hemoptysis - etiology; Humans; Lung - pathology; Lung Neoplasms - complications; Necrosis - complications; Positive-Pressure Respiration - adverse effects; Subcutaneous Emphysema - etiology; computed tomography scan; fatality; air embolism; hemoptysis; lung cavern; subcutaneous emphysema
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.03194

The simultaneous occurrence of subcutaneous emphysema and intravascular air due to an air embolism is a rare condition. Here, we report a patient with COPD who developed a severe episode of hemoptysis due to rupture of a previously undiagnosed lung cavern. Intubation and ventilation led to the development of both massive subcutaneous emphysema and a massive air embolism, resulting from aspiration of air through a torn pulmonary vessel in the cavern. The dramatic amount of intravenous air and subsequent conduction along the venous system to the right heart and pulmonary trunk caused major hemodynamic compromise and ultimately death. The degree of subcutaneous emphysema, especially the massive venous air embolism, was unprecedented.