Systemic Venous Air Emboli After Emergent Hyperbaric Therapy for Carbon Monoxide Poisoning

Abstract

BACKGROUND A venous air embolism is a rare condition but could have a disastrous effect on vital organs. It usually occurs due to iatrogenic sources, such as central venous catheter insertion, neurosurgery, and other invasive procedures. In most cases, hyperbaric oxygen therapy (HBOT) is the best treatment for those conditions. However, multiple venous air emboli after hyperbaric oxygen therapy has not been reported in the literature. CASE REPORT An 82-yr-old woman came to the Emergency Department after inhalation of fumes at the scene of a house fire. She had dizziness and nausea. Her vital signs were normal at the time of presentation. She received HBOT for carbon monoxide poisoning. Soon after the HBOT, the patient started to have dizziness, abdominal pain, and leg pains. Computed tomography scans showed multiple systemic venous air emboli throughout the portal venous system and femoral veins. The air emboli totally disappeared after HBOT with a longer ascent time. CONCLUSIONS To the best of our knowledge, this is the first case of multiple systemic venous air bubbles after emergent HBOT. Physicians should be aware of any kind of complications when treating patients who need HBOT in the emergent setting. Although decompression sickness following HBOT is extremely rare, it should not be ignored by emergency physicians.

Figure 1.

(A) Axial enhanced abdominal computed tomography (CT) at the level of the hepatic hilum shows portal venous gas (arrow). (B) Axial CT image through the kidneys shows gas in the splanchnic veins. Also noted are small foci of gas in the inferior vena cava (arrowhead) and main portal vein (arrow). Axial CT images show venous air (arrows) in (C) both external iliac veins and (D) femoral veins.

Figure 2.

(A–D) Computed tomography scans show complete resolution of gas throughout the portal system to femoral veins.