Abstract
A 65-year-old man developed respiratory distress during insertion of a central venous catheter (CVC). The presence of gas in the pulmonary trunk and ascending aorta was observed on computed tomography (CT) scans performed immediately after insertion, and paradoxical air embolism (PAE) was diagnosed. There were no symptoms of cerebral or coronary arterial embolism, and the patient was maintained in the same supine position as during CVC insertion. CT conducted after 200 min confirmed disappearance of the gas, and the resting position was discontinued. No subsequent symptoms of PAE occurred. In this patient with respiratory distress during CVC insertion, CT revealed PAE, and PAE was resolved and systemic arterial embolism did not occur by maintenance of the supine position and O2 administration. This case also highlights the potential risk for the occurrence of asymptomatic PAE related to CVC insertion.
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References
Eichhorn V, Bender A, Reuter DA. Paradoxical air embolism from a central venous catheter. Br J Anaesth 2009;102:717–718.
Copetti R, De Monte A. Rapid echocardiographic diagnosis of suspected paradoxical gas embolism after central venous catheter placement in the upright position. Echocardiography 2005;22:695–696.
Heckmann JG, Lang CJ, Kindler K, Huk W, Erbguth FJ, Neundorfer B. Neurologic manifestations of cerebral air embolism as a complication of central venous catheterization. Crit Care Med 2000;28:1621–1625.
Mammoto T, Hayashi Y, Ohnishi Y, Kuro M. Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position: detection by transesophageal echocardiography. Acta Anaesthesiol Scand 1998;42:643–647.
Lynch JJ, Schuchard GH, Gross CM, Wann LS. Prevalence of right-to-left atrial shunting in a healthy population: detection by Valsalva maneuver contrast echocardiography. Am J Cardiol 1984;53:1478–1480.
Lee SY, Choi BI, Kim JS, Park KS. Paradoxical air embolism during hepatic resection. Br J Anaesth 2002;88:136–138.
Marquez J, Sladen A, Gendell H, Boehnke M, Mendelow H. Paradoxical cerebral air embolism without an intracardiac septal defect: case report. J Neurosurg 1981;55:997–1000.
Purandare N, Oude Voshaar RC, McCollum C, Jackson A, Burns A. Paradoxical embolization and cerebral white matter lesions in dementia. Br J Radiol 2008;81:30–34.
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Kariya, S., Tanigawa, N., Komemushi, A. et al. Asymptomatic paradoxical and symptomatic pulmonary air embolism during central venous catheter insertion. Jpn J Radiol 28, 473–475 (2010). https://doi.org/10.1007/s11604-010-0447-8
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DOI: https://doi.org/10.1007/s11604-010-0447-8