case_images: PMC10481802_01
case_images: Initial computerized tomography (CT) demonstrating air emboli (a, white arrows). Loss of blood flow noted in the affected area on CT angiography (CTA) (b, white arrow). CTA scout image showing R-sided peripherally inserted central catheter with correct placement (c, white arrow). Repeat CT within 24 h after initial CT shows improvement in air after 100% fraction of inspired oxygen (d).
case_images: SNI-14-285-g001.jpg
case_images: PMC10481802_01_SNI-14-285-g001.jpg
case_images: F1
case_images: NCSE. Noncontrast computerized tomography (CT) of the head revealed air within the right greater than left hemispheric cortical vessels with loss of sulcation, suggestive of ischemia due to cerebral air embolism (CAE) [Figure 1a]. CT angiography (CTA) of the head showed absent opacification of the distal cortical vessels in the right anterior cerebral artery and middle cerebral artery territories [Figure 1b]. The distal end of the patient's peripherally inserted central catheter (PICC) line, previously placed for antibiotic administration, was in the appropriate position on the scout CTA imaging [Figure 1c]. Subsequent CT head at 24 hours (h) after the last known well-showed near-complete resolution of the air emboli after continued treatment with 100% FiO2, though there was the evident loss of sulcation in the right hemisphere [Figure 1d]. Although the PICC line was noted to be ipsilateral to the more affected hemisphere, this was confirmed to be in the correct position on CTA scout imaging during the patient's emergent evaluation and, thus, was not felt to be the source of air entry into the venous circulation [Figure 1c].
case_images: Axial diffusion-weighted imaging (DWI) (a) and fluid-attenuated inversion recovery (FLAIR) (b) images from magnetic resonance imaging (MRI) brain obtained 5.75 h after last known normal and repeat MRI from day 5 (c: DWI; d: FLAIR), demonstrating delayed evolution of cortical ischemia with adjacent white matter edema.
case_images: SNI-14-285-g002.jpg
case_images: PMC10481802_01_SNI-14-285-g002.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) of the brain obtained 5.75 h from the last known well showed areas of subtle cortical diffusion restriction, but there was no evidence of definitive infarction [Figures 2a and b]. Repeat MRI obtained 4 days after the stroke code activation (hospital day 17) demonstrated cortical diffusion restriction in a gyriform pattern throughout multiple vascular territories without associated cerebral edema [Figures 2c and d].