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Air in unusual location after contrast-enhanced computed tomography.

Gorsi U, Sodhi KS, Yadav BS, Khandelwal N - Lung India (2015 Nov-Dec)

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India.

AUTOMATICALLY GENERATED EXCERPT
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Air entered the venous system inadvertently during injection of the contrast medium by the power injector... The patient did not receive any treatment, as she was asymptomatic and on clinical examination was found to be hemodynamically stable... Small (less than 1 cm in diameter) and medium (few small bubbles or 1 to 2 cm bubble-sized) venous air emboli (VAE) are reported to occur in 11 to 23% of the patients undergoing contrast-enhanced CT examination... Pham et al. have reported two non-fatal cases, where 135 ml of air was injected into the venous system by power injectors during CECT... Venous air embolism during a contrast-enhanced CT scan is being increasingly reported as a non-fatal event... The main pulmonary artery and the axillary and subclavian veins are the most common locations for the entrapment of air and are easily detected on a CT scan as air bubbles or air-fluid levels... Few medical conditions allow a VAE to enter the arterial circulation, increasing the risk of significant complications manifold... Extreme caution must be ensured to prevent air embolism, even during routine administration of intravenous contrast or fluids, in this selective group of patients... Small to medium VAE do not require any treatment... In severe cases of VAE, placing the patient in the left lateral decubitus and Trendelenburg (Durant) positions is advised... This leads to trapping of air in the apex of the right ventricle and reduces the air-lock in the right ventricular outflow... Placing the patient on 100% oxygen may also be considered, to facilitate resorption of the trapped air in the vascular system... This radiology quiz illustrates the awareness of this entity, which is important for emergency physicians and radiologists, so that it may not lead to a red herring signal and lead to many more invasive diagnostic tests, which may be unnecessary and only consume the limited emergency resources available.

No MeSH data available.


Axial multiplanar reformatted (MPR) image showing air in the brachiocephalic vein (arrow)
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Figure 2: Axial multiplanar reformatted (MPR) image showing air in the brachiocephalic vein (arrow)

Mentions: A 45-year-old woman, who was operated two years back for carcinoma left breast and had completed radiotherapy and chemotherapy underwent a contrast-enhanced computed tomography (CECT) scan for routine follow-up. A CT scan of the chest and abdomen was done, with oral and intravenous contrast. Non-ionic intravenous contrast (100 mL) was injected with a power injector, through the left antecubital vein. The CT scan revealed a patch of fibrosis in the upper lobe of the left lung, absent left breast, and hepatic steatosis. No locoregional or distant metastasis was seen. In addition, the radiologist conducting the study noticed the presence of air in an unusual location [Figures 1 and 2].


Air in unusual location after contrast-enhanced computed tomography.

Gorsi U, Sodhi KS, Yadav BS, Khandelwal N - Lung India (2015 Nov-Dec)

Axial multiplanar reformatted (MPR) image showing air in the brachiocephalic vein (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663877&req=5

Figure 2: Axial multiplanar reformatted (MPR) image showing air in the brachiocephalic vein (arrow)
Mentions: A 45-year-old woman, who was operated two years back for carcinoma left breast and had completed radiotherapy and chemotherapy underwent a contrast-enhanced computed tomography (CECT) scan for routine follow-up. A CT scan of the chest and abdomen was done, with oral and intravenous contrast. Non-ionic intravenous contrast (100 mL) was injected with a power injector, through the left antecubital vein. The CT scan revealed a patch of fibrosis in the upper lobe of the left lung, absent left breast, and hepatic steatosis. No locoregional or distant metastasis was seen. In addition, the radiologist conducting the study noticed the presence of air in an unusual location [Figures 1 and 2].

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Air entered the venous system inadvertently during injection of the contrast medium by the power injector... The patient did not receive any treatment, as she was asymptomatic and on clinical examination was found to be hemodynamically stable... Small (less than 1 cm in diameter) and medium (few small bubbles or 1 to 2 cm bubble-sized) venous air emboli (VAE) are reported to occur in 11 to 23% of the patients undergoing contrast-enhanced CT examination... Pham et al. have reported two non-fatal cases, where 135 ml of air was injected into the venous system by power injectors during CECT... Venous air embolism during a contrast-enhanced CT scan is being increasingly reported as a non-fatal event... The main pulmonary artery and the axillary and subclavian veins are the most common locations for the entrapment of air and are easily detected on a CT scan as air bubbles or air-fluid levels... Few medical conditions allow a VAE to enter the arterial circulation, increasing the risk of significant complications manifold... Extreme caution must be ensured to prevent air embolism, even during routine administration of intravenous contrast or fluids, in this selective group of patients... Small to medium VAE do not require any treatment... In severe cases of VAE, placing the patient in the left lateral decubitus and Trendelenburg (Durant) positions is advised... This leads to trapping of air in the apex of the right ventricle and reduces the air-lock in the right ventricular outflow... Placing the patient on 100% oxygen may also be considered, to facilitate resorption of the trapped air in the vascular system... This radiology quiz illustrates the awareness of this entity, which is important for emergency physicians and radiologists, so that it may not lead to a red herring signal and lead to many more invasive diagnostic tests, which may be unnecessary and only consume the limited emergency resources available.

No MeSH data available.