We present a case of a 64-year-old male with a patent foramen ovale who suffered severe complications from a massive air embolism while accessing a tunneled CVC. Air embolism may occur in conjunction with trauma, diving accidents, hemodialysis, cardiopulmonary bypass surgery, neurosurgery, thoracic biopsies, or transpulmonary passage from barotrauma, but it is most often associated with central venous catheter (CVC) insertions [1]. Arterial air embolisms, particularly cerebral air embolisms, are a rare and potentially fatal event that may result in severe, irreversible neurological deficits [2]. High index of suspicion is necessary, especially in those with an underlying cardiac defect such as a patent foramen ovale (PFO), where a paradoxical embolism may occur. With an underlying PFO, a baseline left to right shunt may undergo reversal of the shunt due to a raise in the right atrial pressures, mostly associated with Valsalva, and thus result in cerebral arterial embolism [1,3].