Enhancing vigilance for cerebral air embolism after pneumonectomy: a case report

Abstract

Background: Vascular air embolism (VAE) is a rare but important complication that has not been paid enough attention to in the medical process such as surgery and anesthesia.

Case presentation: We report for the first time that a 54-year-old male patient with central lung cancer developed severe complications of CAE after right pneumonectomy. After targeted first-aid measures such as assisted breathing, mannitol dehydration and antibiotic treatment, the patient gradually improved. The patient became conscious at discharge after 25 days of treatment but left limb was left with nerve injury symptoms.

Conclusion: We analyzed the possible causes of CAE in this case, and the findings from this report would be highly useful as a reference to clinicians.

Keywords: Cerebral air embolism; Neurological recovery; Pneumonectomy.

Fig. 1

Chest CT of right central lung cancer. a. Cross-sectional, lung window showed right central lung cancer. b. Mediastinal window, tumor invaded right main bronchus and right pulmonary artery trunk. c d. Frontal plane, right central lung cancer invade right main bronchus and right pulmonary artery trunk

Fig. 2

A large amount of gas is present in the interstitial space of the neck

Fig. 3

CTA results showed that there were no abnormalities such as embolism in the main cerebral artery

Fig. 4

Multiple free air can be seen in the blood vessels of bilateral frontal sulcus as indicated by the arrows

Fig. 5

Dispersed free air was seen in the vessels of the right occipital lobe and suspicious cerebral infarction lesions were seen

Fig. 6

Significant reduction in cerebral air embolism 24 h after treatment

Fig. 7

Three days after air embolism, CT showed a patchy low-density shadow in bilateral thalamic basal ganglia (yellow area), temporal lobe (red area) and occipital lobe (black area), which was the cerebral infarction lesion after air embolism