CTICasesMacroscopic Air Emboli to Pulmonary Arteries
Imaging findings
CT reveals oligo-attenuation and filling defects in the right upper lobe, consistent with macroscopic air emboli within the pulmonary arteries. These air-filled vessels appear to parallel adjacent airways, creating a "double-barrel bronchus sign." Concomitant decreased peripheral perfusion is noted in the affected segments, along with air in the main pulmonary artery and right ventricle. Follow-up imaging the next day showed complete resolution of the findings, with normal opacification and restoration of flow.
Key takeaways
Macroscopic air emboli in the pulmonary arteries can present with striking imaging findings such as air-filled vessels paralleling airways and associated regional hypoperfusion. This phenomenon, which can include air in the right heart, can resolve spontaneously. The "double-barrel bronchus sign" describes the appearance of an air-filled pulmonary artery alongside a bronchus.
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