Abstract Introduction Cerebral air embolism (CAE) is a known complication of certain medical procedures, a systematic review of case reports (1) showed 5 instances of chest tubes leading to iatrogenic cerebral air embolism. Cases have been reported of CAE following insertion of chest tube for pleural fluid drainage (2) and after fibrinolytic therapy with streptokinase (3). We present a case of a patient who suffered a CAE after having his pigtail catheter flushed with betadine 24 hours after administration of fibrinolytic therapy. Case report 80 y/o male patient with a history of CAD s/p CABG 2021, HFrEF, Afib, CKD, Hypothyroidism, and a persistent right sided pleural effusion (with persistent chest wall abscess concerning for empyema necessitans) for three years. He then presented to the ED for acutely worsening chest wall swelling and pain. CT Chest showed chronic loculated right pleural effusion with recurrence of fluid in the subcutaneous tissues overlying the 7/8 ribs continuous with pleural effusion (Day 1).IR guided right pigtail drain on day 2 placed into pleural effusion with purulent drainage (culture positive for pan sensitive Enterococcus Faecalis) after consultation with pulmonary and thoracic surgery. Fibrinolytic therapy was administered via pigtail to help with further drainage on day 3 and day 4. Repeat CT chest on Day 4 showed a decrease in size of empyema and improved septations. On day 5, diluted sterile betadine was flushed into the pigtail to help transition the pigtail to a JP bulb for long term use. At this time, he had an acute change in mental status with right-sided weakness and aphasia. Code stroke initiated, CT Head and CTA H/N showed scattered foci of air in the subarachnoid space, large MCA infarct and small acute infarct in the left cerebellum. MRI brain showed diffusion restriction in similar areas. He started on 100% oxygen therapy, neurological exam notable for dysarthric speech, right sided gaze deviation, left facial droop and left sided weakness. He also developed stress induced cardiomyopathy with TTE showing apical hypokinesis but negative for right to left shunt. CT Angiogram of chest/abdomen/pelvis did not show any evidence of shunting. Patient had pigtail removed and was able to transfer back to the floor after initiation of DAPT. Conclusion CAE can cause significant mortality and morbidity; it must be recognized as a possible complication of invasive procedures. The exact cause of this phenomenon is not known, and further research is needed in this area. This abstract is funded by: None
Aguilar et al. (Fri,) studied this question.