Air Embolism during an Aircraft Flight in a Passenger with a Pulmonary Cyst: A Favorable Outcome with Hyperbaric Therapy

Closon, Mathieu; Vivier, Emmanuel; Breynaert, Charles; Duperret, S.; Branche, P.; Coulon, A.; Delafosse, B.

doi:10.1097/00000542-200408000-00037

Cited by 28 publications

(20 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The pressure changes described are reached within 20 min of take-off. In the present case, onset of symptoms occurred 15 min following take-off and previous reports of pulmonary cyst rupture during air travel describe onset of symptoms 10-20 min after commencement of the flight [3][4][5].…”

Section: Case Reportsupporting

confidence: 61%

“…The mainstays of treatment are an inspiratory oxygen fraction of 1 to facilitate nitrogen washout, together with hyperbaric oxygen therapy, subject to availability, to reduce the volume of entrained air and increase its absorption rate. A previous report of the use of hyperbaric oxygen therapy instituted 48 h following an in-flight air embolus resulted in rapid resolution of symptoms [5]. Given that mortality, even with such supportive measures, appears high when embolisation does occur, the present authors suggest that patients with asymptomatic intrapulmonary cysts should be advised against activities leading to rapid changes in ambient pressure or consider elective surgical treatment.…”

Section: Case Reportmentioning

confidence: 74%

“…Changes in atmospheric pressure may cause previously asymptomatic pulmonary cysts to rupture causing pneumothorax, haemothorax or air embolism. Gaseous embolism as a consequence of underwater diving is well recognised, but there are only three previous reports of air embolism during air travel, two of which were fatal [3][4][5]. This is the first reported case of air embolism as a result of a CCAM.…”

Section: Case Reportmentioning

confidence: 82%

See 2 more Smart Citations

Congenital cystic adenomatoid malformation presenting as in-flight systemic air embolisation

Belcher

Lawson²,

Nicholson³

et al. 2007

Eur Respir J

View full text Add to dashboard Cite

Congenital cystic adenomatoid malformations (CCAMs) are rarely diagnosed in adulthood. The present case study reports a case of a CCAM presenting as a cerebral air embolus during an international flight.In the present case, supportive therapy resulted in a full recovery. The patient later underwent elective excision of the pulmonary malformation.Since the overall mortality of in-flight cerebral air embolisation is high, patients with such asymptomatic cysts should be considered for elective surgery.KEYWORDS: Congenital lung disease, stroke, thoracic surgery T he term congenital cystic adenomatoid malformation (CCAM) of the lung encompasses a spectrum of conditions from disordered airway development (types 0, 1 and 2) to abnormalities in the development of alveolar parenchyma (type 4; table 1) [1]. Symptoms of the latter type commonly include respiratory failure or infection. The present case study describes a type-4 CCAM presenting as a cerebral air embolus during an international flight. CASE REPORTA 17-yr-old male nonsmoker collapsed suddenly 15 min after take-off during a flight from London, UK, to Salzburg, Austria. He had flown uneventfully on four previous occasions. He initially complained of generalised ''pins and needles'' followed by loss of consciousness and urinary incontinence without evidence of seizure. He regained consciousness shortly prior to landing. On admission to hospital, he had a left hemiparesis and bulbar palsy. Computed tomography (CT) and magnetic resonance imaging of the brain showed no abnormalities. An EEG was performed and found to be normal. Laboratory investigations were normal, with the exception of a mildly raised troponin T (0.07 ng?mL -1 ). All neurological signs and symptoms resolved within 72 h and hyperbaric oxygen therapy was not instituted. A chest radiograph ( fig. 1) showed a large thin-walled cyst in the left upper lobe. CT of the chest ( fig. 2) revealed a 9-cm thin-walled cystic airspace in the left upper lobe with peripherally displaced vessels. A further smaller cystic lesion was noted in the posterobasal segment of the left lower lobe. Transthoracic echocardiography was normal. Aspirin therapy was commenced and he returned to the UK by ground transportation 10 days after presentation. At his local hospital he underwent a normal transoesophageal echocardiogram effectively ruling out paradoxical embolisation via a patent foramen ovale. A ventilation scan showed absence of ventilation in the left upper zone lesion. Spirometry recorded a forced expiratory volume in one second of 4.35 L (98% predicted) and a forced vital capacity of 4.82 L (92% pred), with a residual volume of 1.89 L (114% pred). He was referred for surgical treatment.The patient remained well and underwent elective left thoracotomy, atypical excision of the left apical segment of the upper lobe and wedge resection of the lower lobe cyst. Histological examination of both lesions showed features characteristic of a type-4 CCAM, with disordered cystic dilated airspaces lined by type-2 pneumoc...

show abstract

Section: Case Reportsupporting

confidence: 61%

Section: Case Reportmentioning

confidence: 74%

Section: Case Reportmentioning

confidence: 82%

See 1 more Smart Citation

Congenital cystic adenomatoid malformation presenting as in-flight systemic air embolisation

Belcher

Lawson²,

Nicholson³

et al. 2007

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Six of the 8 published patients, including ours, died as a result of cerebral ischaemic lesions despite 3 of them having received hyperbaric oxygen therapy. Only 2 patients completely recovered, included 1 treated by hyperbaric oxygen therapy at 48 h, good prognosis being probably related more to the limited extent of the cerebral lesions than to late hyperbaric oxygen therapy [2]. …”

Section: Discussionmentioning

confidence: 99%

Sudden Loss of Consciousness during a Flight

et al. 2014

View full text Add to dashboard Cite

“…18 In one case report, a comatose patient with CAGE secondary to a ruptured pulmonary cyst was treated with hyperbaric oxygen therapy 48 hours after presentation and made a full neurologic recovery. 19 Although rare, CAGE should be considered when a patient develops sudden loss of consciousness or a seizure during a flight. Patients presenting after an inflight seizure require a chest radiograph to assess for an intrapulmonary cyst.…”

Section: Learning Pointsmentioning

confidence: 99%

In-flight arterial gas emboli from a ruptured bronchogenic cyst

Mak

Cheung

Mondor

2013

CJEM

View full text Add to dashboard Cite

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...

show abstract

Air Embolism during an Aircraft Flight in a Passenger with a Pulmonary Cyst: A Favorable Outcome with Hyperbaric Therapy

Cited by 28 publications

References 5 publications

Congenital cystic adenomatoid malformation presenting as in-flight systemic air embolisation

Congenital cystic adenomatoid malformation presenting as in-flight systemic air embolisation

Sudden Loss of Consciousness during a Flight

In-flight arterial gas emboli from a ruptured bronchogenic cyst

Contact Info

Product

Resources

About