Massive paradoxical air embolism in brain occurring after central venous catheterization: a case report

Abstract

Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.

Keywords: Catheterization, Central Venous; Complications; Embolism, Air.

Fig. 1

Brain MRI. Diffusion-weighted brain MR imaging (A) demonstrated diffuse hyperintensity involving the whole of the right cerebral hemisphere, which was seen as an area of low signal intensity suggesting acute infarction on the apparent diffusion coefficient map (B). Numerous air bubbles (arrows) were seen within the infarct region.

Fig. 2

Immediate non-contrast brain CT showed an extensive lesion with low attenuation as well as air bubbles (arrows) in the right cerebral hemisphere.

Fig. 3

Chest CT showed star-shaped lesions with low attenuation (arrows) suggesting air bubbles in the right atrium and destruction of the right lung with tuberculosis.

Fig. 4

Transesophageal echocardiography demonstrated air bubbles in the aorta and right ventricular outflow tract (arrows). LA, left atrium; LVOT, left ventricular outflow tract; Ao, aorta; RVOT, right ventricular outflow tract.