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Systemic air embolism during pleural lavage for empyema
Masatsugu Ohuchi1, Shuhei Inoue2, Yoshitomo Ozaki2
1Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashi-Ohmi, Shiga, 527-8505, Japan. ohuchi-masatsugu@shiga-hosp.jp.
General Thoracic and Cardiovascular Surgery
|December 18, 2016
Summary
Systemic air embolism is a rare complication of pleural lavage for empyema. This case highlights potential risk factors and suggests alternative treatments to prevent this serious adverse event.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Pleural lavage is a common and generally safe procedure for managing empyema.
- Empyema, an infection of the pleural space, requires effective drainage and treatment.
Observation:
- A 53-year-old male patient undergoing pleural lavage in a sitting position developed sudden left-sided paralysis and altered consciousness.
- Computed tomography confirmed the diagnosis of systemic air embolism.
Findings:
- The patient's presentation suggests that factors such as fibrinolytic agent use, the sitting position during lavage, and intrathoracic pressure dynamics may have contributed to the air embolism.
- This case underscores a rare but severe complication associated with pleural lavage.
Implications:
- Consideration of patient positioning and intrathoracic pressure is crucial during pleural lavage.
- Alternative surgical approaches like open decortication or fenestration may be safer in certain empyema cases to avoid air embolism.
- This report emphasizes the need for vigilance and potential modification of techniques in thoracic procedures.
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