Paradoxical air embolism during hepatic resection

Abstract

Systemic venous air embolism is a serious complication in patients with chronic liver disease having liver surgery. Intrapulmonary arteriovenous shunting can permit air emboli to pass into the systemic circulation. We describe a case of paradoxical air embolism detected by transoesophageal echocardiography in a patient with cirrhosis who was having a hepatic resection.

Asymptomatic paradoxical and symptomatic pulmonary air embolism during central venous catheter insertion

“…3 Transesophageal echocardiography monitoring during neurosurgery in the sitting position has also revealed paradoxical embolism even in the absence of pulmonary arteriovenous malformations (AVMs) or intracardiac septal defects. 6,7 In this patient, the search for a pulmonary AVM was negative on CT, but we could not determine if there was patent foramen ovale because of the poor condition of the patient.…”

“…Indeed, many reports on CVC-related PAEs report complication of PAE by pulmonary artery air embolism. 1,6 In patients with symptoms of a pulmonary artery air embolism associated with CVC, irrespective of PAE symptoms, we recommend that the presence or absence of air in the systemic artery be immediately confi rmed, without positioning the head up. If this is not possible, the patient should be maintained for a long time in a position that does not involve putting the head up.…”

Paradoxical air embolism through patent foramen ovale during consensual intercourse in a non-pregnant young female

“…15 Cases of paradoxical air embolism have been reported in subjects with patent foramen ovale, during aviation altitude exposition, diving sports and several medical procedures as cesarean delivery, neurosurgery in sitting position, scoliosis surgery, transplantation or resection liver surgery, central venous catheters management, but no data are available on cases of paradoxical air embolism during consensual sexual activity. [16][17][18][19][20][21] In conclusion, we observe that:…”

“…[1][2][3][4][5] Paradoxical air embolism, which is an uncommon variant of air arterial embolism, occurs in subjects after medical procedures, aviation altitude exposition and diving sports, when air entering the venous circulation crosses a patent foramen ovale and involves the left cardiac chambers and the coronary and brain vessels. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] We report a case of death due to paradoxical air embolism during consensual intercourse in a non-pregnant woman and examine pathophysiologic and medico-legal implications.…”

Venous Air Embolism

“…19 VAE has also been reported during abdominal and pelvic surgery when the operative field is above the heart (Trendelenburg position), for prostate surgery 23 , or while the uterus is exteriorized during cesarean delivery 56 and when pelvic veins or the inferior vena cava are open to air. 26 Hatano et al theorized that during hepatic resection surgery, focal intracaval pressure can be made subatmospheric by manual compression and resultant flow-dependent Venturi effect. 57 Air can then be entrained through adjacent, open hepatic veins that do not collapse easily.…”