Echocardiographic Diagnosis of Air Embolism Associated with Central Venous Catheter Placement: Case Report and Review of the Literature

Abstract

Transthoracic echocardiography (TTE) is a valuable tool in the evaluation of patients with suspected air embolism. This report describes the presentation and evaluation of a critically ill woman with spontaneous air embolism occurring during a central venous catheter replacement. Bedside TTE established the diagnosis of air embolism, allowing prompt initiation of appropriate therapy. This case report highlights this uncommon but potentially life-threatening complication of central line placement and the utility of echocardiography in its evaluation.

Tangential Gunshot Wound to the Chest Causing Venous Air Embolism: A Case Report and Review

“…In a small case series of blunt trauma patients by Saada et al, TEE was used to diagnose SAE and to adjust ventilator settings (decrease airway pressure), resulting in cessation of air embolism on TEE (20). Maddukuri et al describe a case of VAE due to central venous catheter placement, in which the diagnosis was made by bedside TTE, allowing prompt initiation of appropriate therapy (18). Echocardiography may represent a useful tool in the early assessment of patients with suspected SAE, especially because bedside ultrasound is increasingly utilized by emergency physicians to assess unstable patients.…”

“…Echocardiography detects intracardiac air with high sensitivity, with transesophageal echocardiography (TEE) being more sensitive than transthoracic echocardiography (TTE) (7,18,19). Either one allows not only for diagnosis of VAE and cardiac anomalies (resulting in right-to-left shunts), but also for the assessment of volume status, pulmonary hypertension, and contractility.…”

Venous Air Embolism during Surgery, Especially Cesarean Delivery

“…In massive air embolism detected by TTE, hyperdynamic left ventricular function with a dilated right ventricle, dilated right ventricular outflow tract and pulmonary artery, and decreased right ventricular function were observed, but no air was found initially (13). In repeated TTE imaging, a large influx of air filling the right heart and pulmonary artery was demonstrated (13). However, the majority of VAE cases in cesarean section are not fatal and have no adverse sequelae despite its high incidence (29-36).…”

“…These monitoring systems display the late findings of VAE, detecting the complications of VAE and severe physiologic deterioration caused by V A /Q mismatch, right and/or left heart failure, or paradoxical arterial air embolism (13, 34, 58). Therefore, these methods are not suitable for the early detection of VAE, especially in patients under general anesthesia without N 2 O, and negative findings do not guarantee the absence of VAE.…”

“…During laparoscopic cholecystectomy, the incidence is reported to be 69% (12). Also, VAE cases associated with central venous catheters (13), endoscopic procedures (14), or inadvertent injection of air as contrast media (15) have been recently reported. Lung (16) or abdominal trauma (17) can also induce VAE.…”