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Images in Neurology |

Air Embolism With Pneumocephalus

Nicole A. Cipriani, MD; Cheng Hong, MD, PhD; Jordan Rosenblum, MD; Peter Pytel, MD
Arch Neurol. 2009;66(9):1172-1173. doi:10.1001/archneurol.2009.171.
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A 68-year-old woman with a history of poorly differentiated non–small-cell lung cancer underwent bronchoscopy because of coughing to look for possible recurrent disease. The procedure was complicated by severe pulmonary hemorrhage resulting in a blood loss of 1 to 2 L and cardiac arrest with pulseless electrical activity. Cardiopulmonary resuscitation was successful. On the following day she was found to have bilaterally dilated pupils. A head computed tomography scan demonstrated diffuse air embolism with pneumocephalus. Air was seen in the intracranial vasculature, subarachnoid, and intraparenchymal spaces (Figure 1). The patient died that same day. The subsequent autopsy confirmed recurrent carcinoma invading the tracheobronchial wall and pulmonary vasculature. The brain demonstrated multiple cavities of up to 3 cm corresponding to the imaging finding of intraparenchymal air. The cystic cavities did not show any postmortem bacterial growth but were associated with patchy acute ischemic injury in the cerebral cortex and petechial hemorrhages in white matter. The autopsy findings support and illustrate the diagnosis of air embolism and pneumocephalus with secondary infarction (Figure 2).

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Figure 1.

Computed tomography images showing extensive air accumulation within intracranial blood vessels and in the form of localized intraparenchymal accumulations.

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Figure 2.

Autopsy specimen showing large intraparenchymal spaces corresponding to the gas accumulation visualized by computed tomography. There are also petechial hemorrhages and acute hypoxic changes with mottled gray discoloration of the cerebral cortex and focal blurring of the junction between cortical gray and white matter.

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