A 48-year-old male was brought to a community emergency department (ED) after an in-flight collapse while on board a commercial aircraft. He had no complaints prior to boarding and had been on multiple previous commercial flights. He had no previous medical history and was on no regular medications. There was no history of alcohol or street drug abuse. Thirty minutes into the flight, he had a generalized tonic-clonic seizure and became comatose. The aircraft was immediately rerouted to get the patient to the nearest hospital. On ED arrival, the patient had a Glasgow Coma Scale score of 3, temperature of 36.6uC (97.8uF), blood pressure of 210/98 mm Hg, heart rate of 78 beats/min (normal sinus rhythm), respiratory rate of 28 breaths/min, oxygen saturation of 90% on 100% O 2 , and blood glucose of 11.0 mmol/L. On examination, there were no external signs of trauma. He had decreased breath sounds bilaterally, with normal heart sounds and no murmurs. His abdomen was soft and showed no evidence of distention. Both pupils were reactive to light but sluggish.The patient was intubated in the ED for airway protection. A postintubation chest radiograph (Figure 1) was performed, which showed appropriate endotracheal tube depth and a large round opacity in the right lower lobe. An initial electrocardiogram showed a heart rate of 102 beats/min (sinus tachycardia) with no signs of right heart strain or ischemia. Initial bloodwork, including a complete blood count, electrolytes, renal function, liver function tests, lactate, international normalized ratio, and partial thromboplastin time, were all within normal limits, except for a white blood cell count of 17.6 3 10 9 /L (normal , 11.0 3 10 9 /L) and a troponin of 0.12 mg/L (normal , 0.10 mg/L). After intubation, the patient went immediately for a computed tomographic (CT) head scan (Figure 2), which was obtained approximately 2 hours after the in-flight seizure. As seen in the image, the CT head scan showed pneumocephalus with multiple locules of air in the brain parenchyma. Given these findings, the patient proceeded to have a CT chest scan (Figure 3) to identify a potential source for the gas emboli. The CT chest scan revealed a large 8 3 9 3 10 cm right lower lobe bronchogenic cyst with an airfluid level. On the CT chest scan, the cyst was also thought to be communicating with a small bronchiole and the pulmonary vasculature.With the diagnosis of cerebral gas emboli, the patient was immediately transferred to a tertiary care hospital for hyperbaric oxygen therapy. At the receiving hospital, to prevent further air emboli and isolate the right lung, bronchoscopy was performed; a right lung block was inserted, and the endotracheal tube was placed in the left main bronchus. A chest tube was placed directly into the bronchogenic cyst to allow for decompression. The patient was subsequently treated in the hyperbaric chamber. Despite aggressive treatment, the patient developed increasing cerebral edema with midbrain compression and bilateral uncal herniation. A postmortem wedge r...