A52-14 When Air Becomes the Enemy: A Spontaneous Pulmonary Air Embolism in COPD Resolving on Its Own

Introduction Air embolism occurs when air enters the vascular system, obstructing blood flow and potentially causing severe morbidity or death. While most cases are iatrogenic, chronic obstructive pulmonary disease (COPD) can rarely cause spontaneous air embolism. We present a rare case of COPD exacerbation complicated by spontaneous venous air embolism. Case Presentation A 68-year-old male with COPD presented to the emergency department with shortness of breath and wheezing. For hypoxia and respiratory distress, a CT angiogram of the chest was performed, revealing air along the anteriormost and dependent aspect of the main pulmonary artery, concerning for pulmonary air embolism, without right heart strain. Patient had no prior history of trauma or procedures. He was admitted to the ICU for close monitoring and started on heated high-flow nasal cannula. He was placed in the left lateral decubitus position and remained hemodynamically stable. Management included intravenous corticosteroids and bronchodilators for COPD exacerbation, which improved his symptoms. A repeat CT angiogram 24 hours later showed resolution of the intravascular air. The patient was transferred out of the ICU and discharged home three days later after his oxygen requirement returned to baseline. Discussion While COPD is a recognized risk factor for thrombotic pulmonary embolism due to systemic inflammation, immobility, and comorbidities—particularly during exacerbations—air pulmonary embolism is exceedingly rare and not well established in the literature as being associated with COPD. Air embolism typically results from rupture of the alveolar-capillary interface or abnormal communication between the airways and pulmonary vasculature. Management is supportive, emphasizing close monitoring since even small volumes of intravascular air can cause cardiovascular collapse. In stable patients, high-flow oxygen promotes nitrogen washout and air resorption. Left lateral decubitus and Trendelenburg positioning may reduce right ventricular outflow obstruction. In unstable patients, evidence-based guidelines are lacking, and treatment strategies are extrapolated from conventional pulmonary embolism management. Systemic thrombolysis with alteplase or tenecteplase may be considered if not contraindicated, and catheter-directed aspiration or surgical embolectomy can be pursued in refractory cases. Conclusion Air pulmonary embolism is a rare but serious complication of COPD, likely resulting from alveolar rupture or airway-vascular communication during exacerbations. Management is supportive with high-flow oxygen, appropriate positioning, and close monitoring. Evidence-based guidelines are lacking, and treatment is largely adapted from thrombotic embolism management. This abstract is funded by: None