Retrograde Cerebral Air Embolism in a Patient with Intestinal Necrosis:

Abstract

Background: Cerebral venous air embolism is a severeclinical condition related to an unfavourable outcome inpatients with neurological impairment. Cerebral venousair embolism may occur secondarily to arterial or venousinterventions. A rare mechanism of cerebral venous airembolism is retrograde embolism, which is characterizedby gas flow in a direction that is opposite to that of thenormal blood flow.Case Report: A 69-year-old female was admitted to ourhospital with shortness of breath and abdominal pain.Abdominal computed tomography revealed intramuralgas in the bowel and free gas in the mesenteric veins andportal vein. Cranial computed tomography, which wasperformed due to impaired consciousness, demonstratedcerebral air embolism with the appearance of a gyriformpattern. A bedside echocardiography and chest computedtomography revealed no evidence of right-to-left shunt.Conclusion: Cerebral venous air embolism may occurafter pneumatosis intestinalis by a retrograde flow of airfrom the mesenteric veins and portal vein. Low cardiacoutput and supine position are contributing factors for aretrograde flow of air bubbles into the venous circulationof the brain.