Cerebral and Portal Venous Air Embolism: A Complication of PICC Line Placement

Cerebral air embolism is a rare and potentially fatal medical condition that requires prompt recognition and management. Iatrogenic causes such as laparoscopic procedures, hysteroscopy, or central venous catheter (CVC) manipulation are well-documented etiologies. This article presents a case of an 80-year-old female who developed iatrogenic air emboli from CVC manipulation leading to left middle cerebral artery (MCA) syndrome due to suspected right-to-left shunt from pulmonary arteriovenous malformation (pulmonary AVM) or patent foramen ovale (PFO). Preexisting neurological deficits, elevated lactate levels, and sepsis with evidence of systemic hypoperfusion on admission hindered the early detection and treatment of air emboli. This case highlights the need for heightened awareness of CVC-related iatrogenic air embolism, particularly in patients with predisposing conditions such as pulmonary AVM and PFO. Comprehensive treatment strategies, including hyperbaric oxygen therapy, remain critical for achieving better outcomes.