Cerebral arterial air embolism after endobronchial electrocautery: a case report and review of the literature

Abstract

Background: Endobronchial electrocautery is a common and safe therapeutic endoscopic treatment for malignant airway obstruction. Cerebral arterial air embolism (CAAE) is a rare but potentially fatal complication of endobronchial electrocautery.

Case presentation: We present the first case of cerebral arterial air embolism after endobronchial electrocautery. A 56-year-old male with a pulmonary tumour in the right upper lobe received repeated endobronchial electrocautery. During the procedure, he experienced unresponsiveness, hypoxemia and bradycardia, and he developed tetraplegia. Brain computed tomography showed several cerebral arterial air emboli with low-density spots in the right frontal lobe. He received hyperbaric oxygen therapy with almost full recovery, except for residual left-sided weakness.

Conclusions: General physicians should realize that CAAE may be a possible complication of endobronchial electrocautery. Several measures, including avoiding positive pressure, lowering ventilatory pressures if possible, avoiding advancing the bronchoscope to occlude the bronchus and using the non-contact technique, should be used to prevent this devastating complication.

Keywords: Air embolism; Bronchoscopy; Endobronchial electrocautery; Hyperbaric oxygen therapy.

Fig. 1

The bronchoscopy showed that the posterior segment of the RUL bronchus was completely obstructed by the tumour (a, arrow). Endobronchial electrocautery was used to debulk the tumour (b). Bronchoscopy showed the posterior segment after ablation (c)

Fig. 2

The cerebral CT scan following bronchoscopy showed multifocal cerebral air embolisms in the right frontal lobe (arrows)

Fig. 3

The repeated cerebral CT scan performed 24 h after bronchoscopy demonstrated no signs of air embolism