Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

Abstract

Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal.

An unusual complication of pigtail catheter insertion

“…Another case of cerebral air embolism that proved fatal was reported by Alkhankan et al They describe a case of a 50-year-old man who became suddenly unresponsive and apneic followed by development of left-sided weakness during insertion of a pigtail catheter. CT angiogram was consistent with air emboli in the right main cerebral artery (5). Kim et al reported a case of subclavian artery laceration during removal of the pigtail catheter that was inadvertently placed in the first intercostal space leading to massive hemorrhage and hypovolemic shock upon removal (6).…”

Transection of lung as rare complication of pigtail catheter placement

“…Although minor complications such as blockade, kinking, tubal dislodgement, small pneumothoraces, pain and infection can be seen with the use of pigtail catheters, more serious complications like hemothorax, pneumothoraces, rupture of diaphragm, and damage to other organs are more commonly observed with large-bore chest tubes than with pigtail catheters [2] . However, rare complications associated with the use of pigtail catheters such as cerebral air embolus and systemic air embolus in addition to 3 cases of parenchymal lung injury following catheters insertion have been documented in the literature [3 , 4] .…”

An Unusual Complication of Pigtail Catheter: Colonic Penetration

“…Severe complications (such as pneumothorax, hemothorax, and hepatic perforation) constitute 5% of the complications associated with pigtail catheter placement (Bediwy & Amer, 2012; Shen, Huang, Chen, & Tu, 2014). As rare complications in the literature, left ventricular penetration subclavian artery laceration and cerebral air embolism (Alkhankan et al, 2016; Kim, Cho, Suh, Yang, & Jeon, 2015) have been reported. In addition, pulmonary intraparenchymal insertion cases have been associated with the insertion of a pigtail catheter due to pneumothorax (Garcia de Alencar, Pinheiro Costa, Brandao Neto, & de Souza, 2020; Saqib, Ibrahim, & Maroun, 2018) and a case of sudden visual impairment after pigtail catheter placement has been reported (Kim et al, 2013).…”

“…Pigtail catheter insertion is generally safe and has a low complication rate. Complications such as hemothorax, pneumothorax, lung penetration, subclavian artery laceration, left ventricular penetration, hepatic perforation, and cerebral air embolism can occur due to pigtail catheter placement (Alkhankan, Nusair, Mazagri, & Al-Ourani, 2016).…”