Retrograde Cerebral Air Embolism in a Patient with Intestinal Necrosis: A Case Report

Abstract

Background: Cerebral venous air embolism is a severe clinical condition related to an unfavourable outcome in patients with neurological impairment. Cerebral venous air embolism may occur secondarily to arterial or venous interventions. A rare mechanism of cerebral venous air embolism is retrograde embolism, which is characterized by gas flow in a direction that is opposite to that of the normal blood flow.

Case report: A 69-year-old female was admitted to our hospital with shortness of breath and abdominal pain. Abdominal computed tomography revealed intramural gas in the bowel and free gas in the mesenteric veins and portal vein. Cranial computed tomography, which was performed due to impaired consciousness, demonstrated cerebral air embolism with the appearance of a gyriform pattern. A bedside echocardiography and chest computed tomography revealed no evidence of right-to-left shunt.

Conclusion: Cerebral venous air embolism may occur after pneumatosis intestinalis by a retrograde flow of air from the mesenteric veins and portal vein. Low cardiac output and supine position are contributing factors for a retrograde flow of air bubbles into the venous circulation of the brain.

Keywords: Mesenteric ischaemia; air embolism; necrosis multidetector computed tomography..

Figure 1. Contrast-enhanced abdominal computed tomography shows pneumatosis intestinalis (white arrow) and air in mesenteric vessels (black arrow)

Figure 2. Contrast-enhanced abdominal computed tomography demonstrates air in portal vein (black arrow).

Figure 3. Unenhanced head computed tomography reveals cerebral air (white arrows) distributed in gyriform pattern in both cerebral hemispheres.