Arterial Air Embolism Due to Blunt Chest Trauma: A Case Report

Abstract

Trauma is the third leading cause of death in Brazil and has a huge impact on the potential years of life lost. Most of the lesions identified are mild and, when treated in time have an excellent prognosis. Air embolism (AE) is a rare but potentially fatal condition, especially after blunt chest trauma, when diagnosis is challenging. A 39-year-old male victim of a motorcycle fall at 60 km/h with moderate traumatic brain injury and chest trauma. There was no change in the primary assessment. In the secondary evaluation, he presented pain on palpation of the anterior chest, and pain in the epigastrium, without peritonitis. The computed tomography (CT) demonstrated the presence of a gaseous focus in the left ventricle (LV); small bilateral pneumothorax foci; areas of lung contusion bilaterally; left kidney and pancreas with signs of ischemia and gaseous foci inside. He was followed in the Intensive Care Unit (ICU) with acute renal failure and pancreatitis, treated conservatively. Then, he was undergone to a cardiac catheterization: absence of significant obstructive coronary artery disease and mild LV systolic dysfunction. He was maintained on 100% O2 until discharge from the ICU and discharged from hospital after 12 days of hospitalization. When the lung parenchyma is injured by a blunt trauma of high kinetics, the pulmonary vessels (PV) and the bronchial tree come into contact and air, under high pressure, enters the PV causing AE. AE is difficult to diagnose in the acute phase as the embolus disappears in about 0.5-30h. [1] Diagnosis is usually made with imaging tests. The treatment of air embolism is eminently supportive. 100% O2 therapy decreases bubble size by forcing nitrogen out of the plunger. The use of a hyperbaric chamber is described and, in more severe cases, it is possible to perform aspiration of the ventricle.