Pulmonary embolism complicated by air embolism
Trombo‐embolismo pulmonar complicado por embolia gasosa
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On admission a peripheral venous catheter had been inserted for fluid replacement and she had undergone computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism. Soon after the exam the patient became confused and drowsy and her respiratory failure worsened significantly without hemodynamic instability. CTPA confirmed the presence of bilateral central and peripheral thrombus and a large amount of air in the brachiocephalic veins, pulmonary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>) and right ventricle (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>). She was considered to have VAE unrelated to the administration of contrast, given a topogram image that suggested the presence of air in the right ventricle before contrast injection (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). It was therefore assumed that the VAE resulted from the placement or manipulation of the peripheral venous catheter previously inserted in another institution. The patient was immediately given normal saline, a Hudson mask was applied and she was placed in left lateral decubitus position (Durant's maneuver) and in the Trendelenburg position, to keep the right ventricular outflow tract lower than the right ventricular cavity causing the air to migrate upwards, minimizing the likelihood of embolism. Her clinical status improved rapidly and she recovered without sequelae. Bedside transthoracic echocardiography showed no acute ventricular dilation or dysfunction, and the patient was transferred to another hospital for hyperbaric oxygen therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient returned to our hospital after two days, and was discharged home three days later.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-04" "fechaAceptado" => "2013-11-12" "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 992 "Ancho" => 1500 "Tamanyo" => 115416 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Air in the brachiocephalic veins and pulmonary artery (blue arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 119759 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Air in the right ventricle, coronal view (green arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1297 "Ancho" => 1500 "Tamanyo" => 141868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Air in the right ventricle, sagittal view (green arrow).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1675 "Ancho" => 1500 "Tamanyo" => 210485 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Topogram image suggesting the presence of air in the right ventricle before contrast injection (red arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonthrombotic pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.G. Jorens" 1 => "E. Van Marck" 2 => "A. Snoeckx" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00141708" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "452" "paginaFinal" => "474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19648522" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous air embolism: clinical and experimental considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.L. Orebaugh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1992" "volumen" => "20" "paginaInicial" => "1169" "paginaFinal" => "1177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1643897" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000004/v1_201406010133/S2174204914001081/v1_201406010133/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000004/v1_201406010133/S2174204914001081/v1_201406010133/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001081?idApp=UINPBA00004E" ]
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| 2018 February | 66 | 1 | 67 |
| 2018 January | 38 | 5 | 43 |
| 2017 December | 68 | 5 | 73 |
| 2017 November | 23 | 8 | 31 |
| 2017 October | 30 | 15 | 45 |
| 2017 September | 25 | 13 | 38 |
| 2017 August | 37 | 22 | 59 |
| 2017 July | 24 | 14 | 38 |
| 2017 June | 31 | 11 | 42 |
| 2017 May | 29 | 6 | 35 |
| 2017 April | 29 | 1 | 30 |
| 2017 March | 29 | 27 | 56 |
| 2017 February | 34 | 4 | 38 |
| 2017 January | 27 | 2 | 29 |
| 2016 December | 32 | 9 | 41 |
| 2016 November | 22 | 3 | 25 |
| 2016 October | 32 | 2 | 34 |
| 2016 September | 29 | 7 | 36 |
| 2016 August | 10 | 2 | 12 |
| 2016 July | 10 | 2 | 12 |
| 2016 June | 11 | 3 | 14 |
| 2016 May | 11 | 4 | 15 |
| 2016 April | 19 | 1 | 20 |
| 2016 March | 22 | 1 | 23 |
| 2016 February | 48 | 15 | 63 |
| 2016 January | 32 | 10 | 42 |
| 2015 December | 43 | 7 | 50 |
| 2015 November | 29 | 3 | 32 |
| 2015 October | 30 | 8 | 38 |
| 2015 September | 26 | 11 | 37 |
| 2015 August | 25 | 7 | 32 |
| 2015 July | 22 | 10 | 32 |
| 2015 June | 12 | 1 | 13 |
| 2015 May | 19 | 4 | 23 |
| 2015 April | 27 | 4 | 31 |
| 2015 March | 14 | 2 | 16 |
| 2015 February | 17 | 4 | 21 |
| 2015 January | 12 | 1 | 13 |
| 2014 December | 39 | 11 | 50 |
| 2014 November | 13 | 0 | 13 |
| 2014 October | 19 | 4 | 23 |
| 2014 September | 32 | 6 | 38 |
| 2014 August | 36 | 8 | 44 |
| 2014 July | 38 | 13 | 51 |
| 2014 June | 44 | 16 | 60 |
Show all
