Frequency and Localization of Nonfatal Venous Air Embolism After Contrast Substance Injection in 64-Detector Computed Tomography

Öz

During diagnostic and interventional radiological procedures, venous air embolism is seen as a nonfatal event. In this study, it was aimed to determine the frequency and localization of nonfatal venous air embolism in contrast enhanced computed tomography (CT). 1654 contrast-enhanced thorax computed tomography examinations performed in the Radiology Unit of our hospital between January 1, 2019 and December 31, 2019. The localization and size of the detected venous air emboli and from which side the contrast agent was administered were recorded. In this study, iatrogenic venous air embolism was seen in 3.1%. The most common localization is the main pulmonary artery (1.81%) and other localizations in order of frequency are left brachiocephalic vein (0.66%), left subclavian vein (0.36%), right brachiocephalic vein (0.30%), right subclavian vein (0.24%), right ventricle ( 0.18%) and right atrium (0.18%). Looking at the size of the venous air embolism, 2.5% small, 0.50% moderate and 0.12% large air embolism were seen. Radiologists should be aware of the possibility of vascular air embolism after contrast agent injection in CT scanning and should be careful.

Anahtar Kelimeler

• venous air embolism
• computed tomography
• contrast
• iatrogenic

64 Dedektörlü Bilgisayarlı Tomografide Kontrast Madde Enjeksiyonu Sonrası Nonfatal Venöz Hava Embolisi Sıklığı ve Lokalizasyonu

Öz

Tanısal ve girişimsel radyolojik işlemlerde kontrast madde verilmesi sırasında venöz hava embolisi nonfatal bir olay olarak görülmektedir. Bu çalışmada, kontrastlı bilgisayarlı tomografide (BT) nonfatal venöz hava embolisinin sıklığını ve lokalizasyonunun tespit edilmesi amaçlanmıştır. Hastanemiz Radyoloji Ünitesinde 1 Ocak 2019-31 Aralık 2019 tarihleri arasında çekilen 1654 kontrastlı toraks bilgisayarlı tomografi tetkiki intravenöz hava varlığı retrospektif olarak değerlendirildi. Tespit edilen venöz hava embolilerin lokalizasyonu, boyutları, kontrast maddenin hangi taraftan verildiği kaydedildi. Bu çalışmada iatrojenik venöz hava embolisi %3.14 oranında görülmüştür. En sık görüldüğü lokalizasyon ana pulmoner arter olup (%1.81) diğer görüldüğü lokalizasyonlar sıklık sırasına göre sol brakiosefalik ven (%0.66), sol subklavyen ven (%0.36), sağ brakiosefalik ven (%0.30), sağ subklavyen ven (%0.24), sağ ventrikül (%0.18) ve sağ atriumdur (%0.18). Venöz hava embolisinin boyutlarına bakıldığında %2.5 oranında küçük, %0.50 oranında orta ve %0.12 oranında büyük hava embolisi görüldü. Radyologlar BT taramada kontrast madde enjeksiyonu sonrası vasküler hava embolisi olabileceğini bilmeli ve dikkatli olmalıdır.

Anahtar Kelimeler

• venöz hava embolisi
• bilgisayarlı tomografi
• kontrast
• iatrojenik

Kaynakça

1. 1. Lanfranco J, Romero LI, Freire AX, et al. Pulmonary Air Embolism: An Infrequent Complication in the Radiology Suite. Am J Case Rep. 2017;18:80-4.
2. 2. Woodring JH, Fried AM. Nonfatal Venous Air Embolism After Contrast Enhanced CT. Radiology. 1988;167:405 7.
3. 3. Groell R, Schaffler GJ, Rienmueller R, et al. VascularAir Embolism: Location, Frequency, And Cause On Electron-Beam CT Studies Of The Chest. Radiology. 1997;202:459–62.
4. 4. Rubinstein D, Dangleis K, Damiano TR. Venous Air Emboli Identified On Head And Neck CT Scans. J Comput Assist Tomogr. 1996;20:559–62.
5. 5. Sodhi KS, Das PJ, Malhotra P, et al. Venous Air Embolism After Intravenous Contrast Administration For Computed Tomography. J Emerg Med. 2012;42:450-1. 6. Jia X, Li X , Li J, et al. Reducing The Incidence Of Venous Air Embolism In Contrast-Enhanced CT Angiography Using Preflushing Of The Power Injector. Clin Radiol. 2020;75:479.e1-479.e7.
6. 7. Sodhi KS, Saxena AK, Chandrashekhar G, et al. Vascular Air Embolism After Contrast Administration On 64 Row Multiple Detector Computed Tomography: A Prospective Analysis. Lung India. 2015;32:216-9.
7. 8. Yeakel AE. Lethal Air Embolism From Plastic Blood-Storage Container. JAMA. 1968;204:267–9.
8. 9. Pham KL, Cohen AJ. Iatrogenic Venous Air Embolism During Contrast Enhanced Computed Tomography: A Report Of Two Cases. Emerg Radiol. 2003;10:147-51.

9. 10. Mirski MA, Lele AV, Fitzsimmons L, et al. Diagnosis And Treatment Of Vascular Air Embolism. Anesthesiology. 2007;106:164-77..
10. 11. ACR. ACR manual on contrast media. In: ACR committee on drugs and contrast media; 2017. Available at: https://www.braccoimaging.com/ sites/braccoimaging.com/files/technica_sheet_pdf/us-en-2018-01-26- manual-ACR-Contrast-Media.pdf. [Accessed 31 May 2017].
11. 12. Rahman A, Jayasinghe R, Rajendran S. Paradoxical Embolism Via A Patent Foramen Ovale: An Important Mechanism Of Cryptogenic Strokes. Circ Cardiovasc Imaging. 2008;1:e9-e10.
12. 13. Price DB, Nardi P, Teitcher J. Venous Air Embolism As A Complication Of Pressure Injection Of Contrast Media: CT Findings. J Comput Assist Tomogr. 1987;11:294-5.
13. 14. Gronert GA, Messick JM, Cucchiara RF, et al. Paradoxical Air Embolism From A Patent Foramen Ovale. Anesthesiology. 1979; 50: 548–49.
14. 15. Black M, Calvin J, Chan KL, et al. Paradoxic Air Embolism In The Absence Of An Intracardiac Defect. Chest. 1991; 99: 754–5.
15. 16. Gorsi U, Sodhi KS , Yadav BS, et al. Air In Unusual Location After Contrast-Enhanced Computed Tomography. Lung India. 2015;32:644-5.