Venous air embolism (VAE) is an entity with potential for severe morbidity and mortality.1 It is predominantly an iatrogenic complication of invasive diagnostic and therapeutic maneuvers.2

A 84-year-old woman was referred to our emergency department from another hospital with acute dyspnea at rest and hypoxemia. 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 (Figure 1) and right ventricle (Figures 2 and 3). 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 (Figure 4). 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.

Figure 1.

Air in the brachiocephalic veins and pulmonary artery (blue arrow).

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Figure 2.

Air in the right ventricle, coronal view (green arrow).

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Figure 3.

Air in the right ventricle, sagittal view (green arrow).

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Figure 4.

Topogram image suggesting the presence of air in the right ventricle before contrast injection (red arrow).

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The patient returned to our hospital after two days, and was discharged home three days later.