Air embolism resulting from contrast agent injection during coronary computed tomography: a case report

Air embolism is a rare but potentially lethal iatrogenic complication. Clinicians must recognize its warning signs and implement timely standardized interventions, as early detection is crucial to reduce morbidity and mortality. This report presents a case of venous air embolism following coronary computed tomography angiography (CCTA).

A 60-year-old female developed air embolism due to contrast agent administration during a coronary CT study, presenting with new-onset dyspnea and dizziness approximately 1 min after the end of contrast injection, immediately after completing the CT scan. Following treatment including high-flow oxygen therapy (10 L/min), fluid resuscitation, and left lateral decubitus position with head down, her vital signs stabilized and arterial blood gas parameters returned to normal. A follow-up CT scan 7 days later showed complete absorption of the air emboli, and the patient was discharged uneventfully.

The patient was diagnosed with grade 1 venous air embolism (VAE) according to the Tubingen VAE grading scale, with an estimated air volume of 5-10mL. The mild clinical manifestations were consistent with the small air volume and slow entry rate, and the patient achieved a favorable prognosis with timely standardized interventions. This case highlights the importance of vigilance for VAE during contrast-enhanced CT, even in patients with mild and non-specific symptoms.

While rare, air embolism can cause mild symptoms with small volumes, but larger volumes may be life-threatening. Air embolism should be suspected in patients with sudden neurological, respiratory or cardiovascular symptoms, especially in the presence of iatrogenic risk factors. Prompt cessation of the embolism source, appropriate patient positioning, high-flow oxygen therapy, and hyperbaric oxygen treatment when indicated should be initiated immediately to minimize air entry into the right ventricular outflow tract. These timely interventions can prevent disease progression, improve patient outcomes and reduce mortality.

This case report does not involve a clinical trial.