Venous Air Embolism from Blunt Chest Trauma

199 A 73-year-old woman was involved in a high-speed motor vehicle collision on a highway. When the ambulance arrived, the woman was found to be in pulseless electrical activity (PEA). Cardiopulmonary resuscitation was initiated and, although return of spontaneous circulation was initially achieved after 4 min, the patient went into PEA arrest three additional times until arrival to the emergency department. After an initial chest x-ray (Figure 1), a computed tomography (CT) scan of the chest revealed a large amount of air in the main pulmonary artery (Figures 2A and 2B, and Figure 3), with small amounts of air present in the right atrium, right ventricle, left and right brachiocephalic trunks (Figure 4), proximal superior vena cava and left subclavian vein. A left first rib fracture, bilateral pneumothoraces and left subclavian vein hematoma were present; trauma to the left subclavian vein was believed to be the source of the air embolism. Although hyperbaric oxygen and aspiration of the air under right heart catheterization were considered, the patient stabilized with mechanical ventilation and vasopressors. A CT scan of the chest 6 h later showed virtually complete resolution of the air in the vessels and heart, and the patient was discharged from hospital two months later.