Vascular air embolism: location, frequency, and cause on electron-beam CT studies of the chest

Abstract

Purpose: To determine the frequency and location of venous air emboli that occur with the use of electron-beam computed tomographic (CT) studies of the chest.

Materials and methods: Findings from 677 patients who underwent chest electron-beam CT with intravenous administration of contrast material were reviewed. Unenhanced CT studies were performed in 127 (18.8%) of these patients while the intravenous cannula was in place but before injection of contrast material.

Results: Air emboli were observed on CT studies in 79 (11.7%) of 677 patients. Emboli were small (up to three air bubbles less than 1 cm in diameter) in 70 (10.3%) patients and were moderate (more than three air bubbles or bubbles 1-2 cm in diameter) in nine (1.3%) patients. Air emboli were located in the main pulmonary artery (n = 54 [8.0%]), superior vena cava (n = 12 [1.8%]), right ventricle (n = 10 [1.5%]), subclavian or brachiocephalic vein (n = 6 [0.9%]), and right atrium (n = 5 [0.7%]). Seven patients (1.0%) had emboli in more than one location. Air emboli were depicted on unenhanced CT scans of seven (5.5%) of 127 patients. No association was found between the frequency of air embolism and injection flow, injection site, or amount or type of contrast agent.

Conclusion: Intravenous administration of contrast material may cause small to moderate-sized air emboli. Knowledge of the common locations of emboli can help radiologists distinguish them from image artifacts or paravasal air collections.