Paradoxical and Retrograde Air Embolism from Pressurized Peripheral Bolus

Table 1

Characteristics of patients with iatrogenic air embolism with cardiac defects in the literature.

Patients	Age (years)	Echo findings	Cause of emboli	Imaging findings	Arterial embolism	Venous embolism	Long-term outcome
1^[2]	81	Small PFO	Peripheral line access and IV fluid administration	R parietooccipital air with subsequent stroke	Not reported	Not reported	L homonymous hemianopsia and L arm weakness
2^[5]	46	No PFO	Unknown	Intravascular air, edema, and tonsil herniation	Bilateral cerebral arteries	None	Death
3^[10]	77	Incompletely closed PFO	Bubble study during TTE	Chronic cerebellar stroke	Not reported	Not reported	3-month mRS: 1
4^[10]	49	PFO with massive shunt	Bubble study during TTE	Normal	Not reported	Not reported	3-month mRS: 0
5^[10]	67	PFO with moderate shunt	Dialysis through CVC with presumed air through PFO	Air bubbles in R MCA cortex with edema	Right MCA	Not reported	3-month mRS: 6
6^[10]	34	PAVMs with massive shunt and no PFO	Air entry directly into PAVMs	Air bubbles in L MCA cortex, bihemispheric strokes	Left MCA	Not reported	3-month mRS: 2
7^[10]	74	PFO with minimal shunt	Air entry in pulmonary veins during lung biopsy	Bihemispheric strokes	Not reported	Not reported	3-month mRS: 1
8^[12]	54	PFO	Removal of the PA catheter	Normal	Not reported	Not reported	No deficits
9^[14]	49	PFO	IV fluids pressure bagged into peripheral IV line	R occipital stroke	Right PCA	None	Not reported
10^[15]	76	PFO	Removal of CVC	R frontal sulcus air and infarct	Not reported	Not reported	No deficits
11^[16]	57	PFO	Right IJV line removal	Cerebral air embolism	Not reported	Not reported	Residual L hemiparesis
12^[17]	43	PFO	Right IJV line removal	Multiple embolic strokes	Not reported	Not reported	Residual L hemiparesis
13^[18]	49	PFO	Right IJV line removal	Air in subarachnoid vessels	Subarachnoid vessels	Not reported	No deficits
14^[21]	83	Not reported	Fluid bolus into peripheral IV	Air in superior ophthalmic vein	Not reported	Superior ophthalmic vein	Not reported
15^[22]	Not reported	Not reported	Injection into peripheral IV	Air in cavernous sinus	Not reported	Cavernous sinus	Not reported
16^[25]	89	No PFO	Right IJV line removal	Air in bilateral cavernous sinus	None	Bilateral cavernous sinus	No deficits
17^[26]	46	PAVM	High intrathoracic pressure breathing against obstructed airway	Air emboli in R hemisphere	Not reported	Not reported	No deficits
18^[27]	51	No PFO	Left subclavian vein line removal	Air in bilateral cavernous sinus	None	Bilateral cavernous sinus	No deficits
Our patient	32	PFO and tricuspid regurgitation	IV fluids pressure bagged into peripheral IV line	Air in SSS, bilateral ACA, MCA, and PCA; diffuse anoxic injury	Bilateral ACA, MCA, and PCA	SSS, bilateral cavernous sinus	Death

PFO, patent foramen ovale; IJV, internal jugular vein; mRS, modified Rankin Score; PCA, posterior cerebral artery; PA, pulmonary artery; MCA, middle cerebral artery; TTE, transthoracic echocardiogram; PAVM, pulmonary arteriovenous malformation; CVC, central venous catheter; ACA, anterior cerebral artery; R, right; L, left.