Two cases of cerebral air embolism caused by chronic lung disease and intestinal ischemia

Abstract

Cerebral air embolism (CAE) is typically associated with diving, trauma, and medical procedures including catheterization and biopsy. Very rarely, some internal diseases can lead to CAE, as opposed to the classic external causes. Here, we report two unusual cases of CAE caused by internal diseases (a pulmonary disease and a bowel one). Case 1 is a 78-year-old male presenting with transarterial CAE led by pneumothorax relating to emphysema and bronchitis based on nontuberculous mycobacterial infection. Case 2 is a 92-year-old male presenting with transvenous CAE arising from hepatic portal venous gas relating to non-occlusive mesenteric ischemia (NOMI). Pulmonary circulation in Case 1 and portosystemic collateral pathways in Case 2 might play an important role in the mechanism of these CAEs, respectively. Although the correct diagnosis of CAE is immediately difficult, it is essential to bear in mind that a pulmonary or bowel disease could be potentially an internal risk of CAE.