Massive Fatal Iatrogenic Venous Air Embolism During Contrast Enhanced Computed Tomography

Kleynberg, Roman Leonid; Demirjian, Berj G.; Kamangar, Nader

doi:10.1378/chest.1119460

Cited by 3 publications

(3 citation statements)

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“…The risk of morbidity or mortality not only is affected to the amount of air but also to the speed of introduction; for this reason, the most serious accidents are linked to the use of injector pumps [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

An unexpected complication: Air embolism during contrast-enhanced computed tomography

Laasri,

Naggar,

Marrakchi

et al. 2024

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

An unexpected complication: Air embolism during contrast-enhanced computed tomography

Laasri,

Naggar,

Marrakchi

et al. 2024

Radiology Case Reports

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“… 4 Indeed, rare cases of fatal massive air embolism through inadvertent power injection of air rather than iodinated contrast media have been reported. 5 …”

Section: Discussionmentioning

confidence: 99%

Iatrogenic peripheral pulmonary air embolism following intravenous contrast administration for CT pulmonary angiography: proposal of the “double bronchus sign”

et al. 2017

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We present a case of iatrogenic extensive air embolism in the peripheral pulmonary arterial tree following intravenous contrast injection for a CT pulmonary angiogram performed to investigate chest pain in a 25-year-old female patient. Small volumes of iatrogenic air embolism following contrast injection are not infrequently encountered incidentally in the central vasculature (brachiocephalic veins, superior vena cava, right cardiac chambers and main pulmonary arteries). To our knowledge, however, this is the only case of extensive peripheral pulmonary arterial air embolism on CT that has been reported in the literature. Despite the extent of peripheral air, this potentially clinically significant complication was relatively inconspicuous at CT interpretation. A new radiological sign, the “double bronchus sign”, is proposed as a useful diagnostic tool. In addition to discussing the imaging features, important safety considerations and principles of immediate management, relevant to all radiologists, are addressed.

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“…While the prevalence of observable air is high, the injection of hazardous air volumes is exceedingly rare. Although an exact lethal dose of air is unknown, case reports suggest that 100mL to 300mL of air injected into the venous system of adults can be fatal [6], [11][12][13][14][15][16][17]. In rare cases, abnormalities such as atrial or ventricular septal defects or arteriovenous malformations may allow air that reaches the heart to transition into arterial circulation [4], [5].…”

mentioning

confidence: 99%

Proactive Air Management in CT Power Injections: A Comprehensive Approach to Reducing Air Embolization

McDermott¹,

Barone²,

Kemper³

2021

IEEE Trans. Biomed. Eng.

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Venous air embolism as a complication of contrast media administration from power injection systems in CT is found to occur in 7%-55% of patients, impacting patient safety, diagnostic image quality, workflow efficiency, and patient and radiographer satisfaction. This study reviews the challenges associated with reactive air management approaches employed on contemporary systems, proposes a novel air management approach using proactive methods, and compares the impact of reactive and proactive approaches on injected air volumes under simulated clinical use. Methods: Injected air volumes from three power injection systems were measured under simulated clinical use via custom air trap fixture. Two of the systems employed reactive air management approaches, while a new system implemented the proposed proactive air management approach. Results: The proactive system injected significantly less air (average of 0.005mL±0.006mL with a maximum of 0.017mL) when compared to two systems with reactive approaches (averages of 0.130mL±0.082mL and 0.106mL±0.094mL with maximums of 0.259mL and 0.311mL, respectively) (p<0.05). CT images were taken of static and dynamic 0.1mL air bubbles inside of a vascular phantom, both of which were clearly visible. Additionally, the dynamic bubble was shown to introduce image artifacts similar to those observed clinically. Conclusion: Comparison of the injected air volumes show that a system with a proactive air management approach injected significantly less air compared to tested systems employing reactive approaches. Significance: The results indicate that the use of a proactive approach could significantly reduce the prevalence of observable, and potentially artifact-inducing, venous air embolism in contrast-enhanced CT procedures.

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Massive Fatal Iatrogenic Venous Air Embolism During Contrast Enhanced Computed Tomography

Cited by 3 publications

References 0 publications

An unexpected complication: Air embolism during contrast-enhanced computed tomography

An unexpected complication: Air embolism during contrast-enhanced computed tomography

Iatrogenic peripheral pulmonary air embolism following intravenous contrast administration for CT pulmonary angiography: proposal of the “double bronchus sign”

Proactive Air Management in CT Power Injections: A Comprehensive Approach to Reducing Air Embolization

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