Retrograde Cerebral Air Embolism in a Patient with Intestinal Necrosis: A Case Report

Abstract

_Cerebral venous air embolism is a severe clinical condition related to an unfavourable outcome in patients with neurological impairment. Cerebral venous air embolism may occur secondarily to arterial or venous interventions. A rare mechanism of cerebral venous air embolism is retrograde embolism, which is characterized by gas flow in a direction that is opposite to that of the normal blood flow. Case Report_ A 69-year-old female was admitted to our hospital with shortness of breath and abdominal pain. Abdominal computed tomography revealed intramural gas in the bowel and free gas in the mesenteric veins and portal vein. Cranial computed tomography, which was performed due to impaired consciousness, demonstrated cerebral air embolism with the appearance of a gyriform pattern. A bedside echocardiography and chest computed tomography revealed no evidence of right-to-left shunt. Conclusion_ Cerebral venous air embolism may occur after pneumatosis intestinalis by a retrograde flow of air from the mesenteric veins and portal vein. Low cardiac output and supine position are contributing factors for a retrograde flow of air bubbles into the venous circulation of the brain_

Keywords

• Mesenteric ischaemia, air embolism, necrosis, multidetector computed tomography

References

1. 1. Bothma PA, Schlimp CJ. II. Retrograde cerebral venous gas embolism: are we missing too many cases? Br J Anaesth 2014;112:401-4.
2. 2. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol 2007;188:1604- 13.
3. 3. Heckmann JG, Lang CJ, Kindler K, Huk W, Erbguth FJ, Neundörfer B. Neurologic manifestations of cerebral air embolism as a complication of central venous catheterization. Crit Care Med 2000;28:1621-5.
4. 4. Laurent PE, Coulange M, Bartoli C, Louis G, Souteyrand P, Gorincour G. Retrograde cerebral venous air embolism: a rare cause of intracranial gas. Diagn Interv Imaging 2014;95:1113-5.
5. 5. Eum da H, Lee SH, Kim HW, Jung MJ, Lee JG. Cerebral air embolism following the removal of a central venous catheter in the absence of intracardiac right-to-left shunting: a case report. Medicine (Baltimore) 2015;94:e630.
6. 6. Cheng CK, Chang TY, Liu CH, Chang CH, Huang KL, Chin SC, et al. Presence of Gyriform Air Predicts Unfavorable Outcome in Venous Catheter-Related Cerebral Air Embolism. J Stroke Cerebrovasc Dis 2015;24:2189-95.
7. 7. Schlimp CJ, Loimer T, Rieger M, Lederer W, Schmidts MB. The potential of venous air embolism ascending retrograde to the brain. J Forensic Sci 2005;50:906-9.
8. 8. Fracasso T, Karger B, Schmidt PF, Reinbold WD, Pfeiffer H. Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model. J Forensic Sci 2011;56(Suppl 1):101-4.

9. 9. Abboud B, El Hachem J, Yazbeck T, Doumit C. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol 20097;15:3585-90.
10. 10. Spanuchart I, Tamura A, Matsuda B, Leo QJ, Sung H. Cerebral Venous Air Embolism Secondary to Mesenteric Infarction. Hawaii J Med Public Health 2016;75:133-6.