14 Mar

Pathogenesis of Cerebral Air Embolism during Neodymium-YAG Laser Photoresection

Pathogenesis of Cerebral Air Embolism during Neodymium-YAG Laser PhotoresectionThe phenomenon of arterial air embolism has been described as a sequela to major thoracic trauma, diving accidents, selective arterial angiography, and central venous catheter malfunctions. Recently, arterial air embolism has been reported as a consequence of transthoracic needle lung aspiration. In addition, the occurrence of cerebral air embolism has been reported with transbronchial lung biopsy in a patient with miliary tuberculosis and, recently, in a patient with pulmonary amyloidosis.- In this report we present a case of acute air embolism complicating YAG laser photoresection of an endobronchial carcinoid.

Case Report
The patient is a 27-year-old, heterosexual, nonsmoking, Caucasian man who was admitted with persistent left lower lobe (LLL) pneumonia. Fiberoptic bronchoscopic examination was performed and demonstrated a large, exophytic, and hypervascular lesion totally occluding the LLL bronchus. The patient reported a long history of flushing associated with childhood “hyperactivity” and “panic attacks” and had been given various tricyclic medications. He described a previous episode of “tachycardia” while taking these medications, which required brief treatment with propranolol. naturalbreastenhancementpill.com

On physical examination, his systemic blood pressure was 160/70 mm Hg, pulse rate 88/min, respirations 20/min, and rectal temperature was 38.3°C. Examination of his head and neck was unremarkable. Cardiac examination demonstrated a regular rhythm, normal Si and S2, without murmurs. There was evidence of decreased breath sounds in the area of the LLL. The results of remainder of the examination were normal. The patients data base included a WBC count of 23,900/cu mm, with a left shift. The electrolytes and hemoglobin values were normal.
Course
Approximately six weeks prior to his transfer to our institution, the patient had developed fever (40.0°C), pleuritic chest pain, and a productive cough of green sputum which failed to resolve on treatment with oral erythromycin on an outpatient basis. At another institution, the patient was noted to have a LLL pneumonia and pleural effusion, while the sputum demonstrated “mixed flora.” He was treated with IV ampicillin and metronidazole. His course was complicated by a subsequent loculated empyema requiring rib resection and open drainage.

Categories: Air Embolism
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