The Utility of Pulse Fluoroscopy During Mediport Insertion to Diagnose Air Embolism

Abstract

An otherwise healthy man in his 40s recently diagnosed with esophageal adenocarcinoma sustained an air embolism during the insertion of a mediport under mild sedation that was noted while using pulse fluoroscopy to ensure good visibility of adequate placement of the catheter tip. Pulse fluoroscopy allowed the early detection of a potentially catastrophic situation caused by air in the right heart and main pulmonary artery, thus allowing prompt correction of the mistake that had allowed the air embolism to occur. Pulse fluoroscopy eliminates or greatly reduces the blurred vision of highly mobile objects and enhances the view of low contrast objects thus enhancing imaging quality.

Figure 1.

Note Mediport catheter distal catheter tip inside the superior vena cava. In the area of the right ventricle, but specifically above the pulmonic valve, note a degree of radiolucency not present in the rest of the cardiac silhouette which is compatible with intracardiac air. This effect is clearly seen in the video loop obtained during the case. Mediport insertion with proximal catheter open to air and distal catheter tip (black arrow) inside the superior vena cava. Letters over cardiac silhouette generated by the air are: pulmonic valve (A), right atrium (B), and right ventricle (C). Video: https://youtu.be/DwEeQ9YPVnI