Image in Cardiology
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" => 595 "Ancho" => 900 "Tamanyo" => 79648 ] ] "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" => 675 "Ancho" => 900 "Tamanyo" => 75415 ] ] "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" => 778 "Ancho" => 900 "Tamanyo" => 88759 ] ] "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" => 1005 "Ancho" => 900 "Tamanyo" => 122954 ] ] "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" => "/08702551/0000003300000004/v1_201405230947/S0870255114000833/v1_201405230947/en/main.assets" "Apartado" => array:4 [ "identificador" => "357" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Imagens em cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000004/v1_201405230947/S0870255114000833/v1_201405230947/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114000833?idApp=UINPBA00004E" ]
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| 2020 Janeiro | 20 | 7 | 27 |
| 2019 Dezembro | 24 | 9 | 33 |
| 2019 Novembro | 18 | 4 | 22 |
| 2019 Outubro | 11 | 8 | 19 |
| 2019 Setembro | 17 | 9 | 26 |
| 2019 Agosto | 21 | 6 | 27 |
| 2019 Julho | 24 | 14 | 38 |
| 2019 Junho | 24 | 6 | 30 |
| 2019 Maio | 29 | 9 | 38 |
| 2019 Abril | 27 | 14 | 41 |
| 2019 Maro | 44 | 10 | 54 |
| 2019 Fevereiro | 44 | 9 | 53 |
| 2019 Janeiro | 24 | 2 | 26 |
| 2018 Dezembro | 66 | 14 | 80 |
| 2018 Novembro | 85 | 7 | 92 |
| 2018 Outubro | 192 | 15 | 207 |
| 2018 Setembro | 61 | 13 | 74 |
| 2018 Agosto | 65 | 13 | 78 |
| 2018 Julho | 46 | 5 | 51 |
| 2018 Junho | 51 | 10 | 61 |
| 2018 Maio | 54 | 14 | 68 |
| 2018 Abril | 82 | 5 | 87 |
| 2018 Maro | 90 | 7 | 97 |
| 2018 Fevereiro | 59 | 5 | 64 |
| 2018 Janeiro | 94 | 6 | 100 |
| 2017 Dezembro | 76 | 9 | 85 |
| 2017 Novembro | 42 | 7 | 49 |
| 2017 Outubro | 37 | 10 | 47 |
| 2017 Setembro | 46 | 6 | 52 |
| 2017 Agosto | 55 | 17 | 72 |
| 2017 Julho | 38 | 5 | 43 |
| 2017 Junho | 60 | 23 | 83 |
| 2017 Maio | 42 | 7 | 49 |
| 2017 Abril | 30 | 3 | 33 |
| 2017 Maro | 45 | 3 | 48 |
| 2017 Fevereiro | 57 | 4 | 61 |
| 2017 Janeiro | 29 | 6 | 35 |
| 2016 Dezembro | 43 | 13 | 56 |
| 2016 Novembro | 47 | 12 | 59 |
| 2016 Outubro | 44 | 12 | 56 |
| 2016 Setembro | 117 | 9 | 126 |
| 2016 Agosto | 27 | 8 | 35 |
| 2016 Julho | 11 | 9 | 20 |
| 2016 Junho | 1 | 6 | 7 |
| 2016 Maio | 15 | 0 | 15 |
| 2016 Abril | 12 | 4 | 16 |
| 2016 Maro | 24 | 5 | 29 |
| 2016 Fevereiro | 47 | 16 | 63 |
| 2016 Janeiro | 43 | 6 | 49 |
| 2015 Dezembro | 51 | 7 | 58 |
| 2015 Novembro | 34 | 7 | 41 |
| 2015 Outubro | 30 | 9 | 39 |
| 2015 Setembro | 35 | 5 | 40 |
| 2015 Agosto | 33 | 6 | 39 |
| 2015 Julho | 32 | 8 | 40 |
| 2015 Junho | 25 | 3 | 28 |
| 2015 Maio | 26 | 8 | 34 |
| 2015 Abril | 23 | 9 | 32 |
| 2015 Maro | 23 | 8 | 31 |
| 2015 Fevereiro | 42 | 8 | 50 |
| 2015 Janeiro | 33 | 8 | 41 |
| 2014 Dezembro | 36 | 9 | 45 |
| 2014 Novembro | 34 | 14 | 48 |
| 2014 Outubro | 45 | 11 | 56 |
| 2014 Setembro | 42 | 7 | 49 |
| 2014 Agosto | 39 | 18 | 57 |
| 2014 Julho | 42 | 29 | 71 |
| 2014 Junho | 55 | 39 | 94 |
| 2014 Maio | 34 | 17 | 51 |
Mostrar tudo
