Fatal massive cerebral air embolism in a lung transplant patient

Massive air embolism has been described in multiple clinical scenarios, especially in critical ill patients who undergo invasive procedures. Nevertheless, air embolism is often unrecognized and a high index of suspicion is required to diagnose this entity. Two previous cases of air embolism in lung transplant patients have been described in the literature; we describe a third case of fatal massive air embolism and cardiovascular collapse in a lung transplant patient.

Case report.

A 52-year-old woman who had a left lung transplant 18 months before admission presented with generalized convulsions and altered mental status. Forty-eight hours after admission and treatment of status epilepticus, she became severely hypotensive and her neurological status deteriorated to brain death. An electrocardiogram showed diffuse ST elevations and a non-contrast head computed tomography demonstrated intravascular air and cerebral edema. Inspection of her intravenous lines did not reveal any leakage or possible port of air entry. An autopsy did not reveal a source of air embolism. Although autopsy did not identify a source for air we suspect that the air originated from the transplanted lung.

This case underscores the potential severe consequences of air embolism and its systemic manifestations. A high index of suspicion for cerebral air embolism is warranted in lung transplant patients who present with neurological symptoms.