Robotic-Assisted Navigational Bronchoscopy Complicated by Systemic Air Embolism

Visual Summary. Clinical Course of Iatrogenic Air Embolism CT = computed tomography; FiO2 = fraction of inspired oxygen; HBOT = hyperbaric oxygen therapy; ICU = intensive care unit; MRI = magnetic resonance imaging; PEA = pulseless electrical activity; STEMI = ST-elevation myocardial infarction; TTE = transthoracic echocardiography.

Figure 1. Electrocardiogram Inferior ST-Segment Elevation Initial electrocardiogram with inferior ST-segment elevations in II, III, and aVF, Irregular rhythm with undiscernible P waves.

Figure 2. Chest Computed Tomography With Contrast: LV Air A large intraventricular air embolism is clearly visualized within the LV; white arrows are pointing to air (black) in the ventricles. Desc Aorta = descending aorta; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.

Figure 3. Head Computed Tomography Without Contrast: Cerebral Edema Imaging showing diffuse effacement of sulci with gray-white matter differentiation grossly preserved; findings were suggestive of cerebral edema.

Figure 4. Chest Computed Tomography Without Contrast: RV Air Demonstrating air in the RV with Swan-Ganz catheter in place, white arrows are pointing to air (black) in the ventricles. Abbreviations as in Figure 2.

Figure 5. Follow-up Head Computed Tomography Without Contrast Effacement of sulci noted to be stable compared with previous computed tomography scan and gray-white matter differentiation remains grossly adequate.

Figure 6. Brain Magnetic Resonance Imaging: Hypoxic-Ischemic Injury Diffuse restricted diffusion is seen across the cerebral cortex, appearing bright on the Trace-weighted image (left) and dark on the apparent diffusion coefficient map (right). This pattern is consistent with severe global hypoxic-ischemic brain injury.