Severe pulmonary oedema after venous air embolism

We present a 59-yr-old Chinese male patient who developed acute pulmonary oedema and cardiovascular collapse following multiple episodes of venous air emboli while in the sitting position for removal of a cervical meningioma. The severity of the pulmonary oedema and cardiovascular disturbance were surprising. Postoperative ventilation and inotropic support were required and five litres of plasma were needed to replace the fluid lost as pulmonary oedema. We discuss the differential diagnosis of the pulmonary changes and review current ideas on the pathogenesis for pulmonary oedema following venous air embolism.