Paradoxical air embolism during percutaneous nephrolithotomy: a case report

Area of Science:

• Urology
• Cardiology
• Vascular Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for kidney stone removal.
• Air embolism is a known but rare complication of PCNL.
• Patent foramen ovale (PFO) can allow venous air emboli to enter arterial circulation, causing paradoxical embolism.

Observation:

• A case of paradoxical air embolism during PCNL is presented.
• The patient had a patent foramen ovale, a remnant of fetal circulation.
• This anatomical variation served as a pathway for air to travel from the venous to the arterial system.

Findings:

• This is the first reported case of paradoxical air embolism during PCNL associated with a patent foramen ovale.
• The PFO facilitated the paradoxical embolism of air introduced during the PCNL procedure.
• The clinical presentation and management of this rare complication are discussed.

Implications:

• Highlights the importance of considering PFO in patients undergoing PCNL, especially if unexplained neurological or cardiovascular symptoms arise.
• Suggests potential need for pre-procedural screening or heightened vigilance in patients with known PFO undergoing PCNL.
• Emphasizes the critical role of PFO as a route for paradoxical embolism in iatrogenic complications.