CTICasesVenous Air Embolism and Non-Cardiogenic Pulmonary Edema
Imaging findings
Chest radiography demonstrates signs of severe non-cardiogenic pulmonary edema, characterized by prominent interstitial and alveolar edema, long septal lines (Kerley B lines), subpleural edema tracking along the interlobar fissures, and extensive bilateral airspace consolidation. Transesophageal echocardiography (TEE) obtained intraoperatively reveals persistent, echogenic air bubbles within the pulmonary artery, indicating substantial flow impedance from the right heart. A follow-up CT scan of the chest shows focal, anteriorly-distributed subsegmental ground-glass and consolidative opacities, which likely represent small pulmonary infarctions resulting from distal air emboli.
Key takeaways
Venous air embolism is a potential hazard of neurosurgical procedures performed in the sitting position, where atmospheric air can enter the venous system via non-collapsing dural venous sinuses. A large air bolus can create an "airlock" in the right ventricular outflow tract or main pulmonary artery, resulting in acute pulmonary hypertension, right heart strain, and non-cardiogenic pulmonary edema. Patients who survive the acute event may develop anterior subsegmental pulmonary infarctions from ischemic damage caused by trapped air bubbles in the pulmonary arterial circulation.
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