Cerebral air embolism: acute imaging

Iatrogenic cerebral air embolism secondary to right subclavian vein recatheterization was imaged acutely by computed tomography (CT) and magnetic resonance imaging (MRI). However, CT showed intravascular air with misleadingly high attenuation values sampled to a minimum of -39 HU. Diffusion-weighted imaging, not previously reported in this setting, clearly showed hyperintense acute infarctions in corresponding vascular territories 8.5 hours postprocedure (less than 6 hours after referable symptomatology noted), whereas T2-weighted fluid-attenuated inversion recovery and turbo gradient spin echo images did not. The combination of CT and diffusion-weighted MRI appears ideal for evaluating suspected cerebral air embolism in the acute setting.