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Complications of cerebral air embolism associated with pleural lavage for empyema

Authors :
Toru Ishihara
Shota Sato
Saki Manabe
Hideki Ozawa
Source :
BMJ Case Reports. 15:e249618
Publication Year :
2022
Publisher :
BMJ, 2022.

Abstract

Standard initial treatment for acute empyema involves antibiotic administration and chest tube drainage; however, pleural lavage with saline is another treatment that mitigates the need for surgical drainage. Although this treatment is recognised as non-invasive and safe, the complications of cerebral air embolism are less recognised.In this case, a man in his late 40s was diagnosed with acute empyema and treated with chest tube (28 Fr) drainage and antibiotics. Empyema remained on follow-up chest imaging; thus intrapleural fibrinolytic therapy (urokinase 120 000 units/day for a total of 3 days) and pleural lavage (0.9% saline 1000 mL/day daily) were administered. During the 10th pleural lavage, the patient suddenly became unconscious. Head imaging revealed a cerebral air embolism. Consequently, he received urgent hyperbaric oxygen therapy and improved without any neurological sequelae.Clinicians should be aware of the complications of sudden cerebral air embolism due to pleural lavage for empyema.

Details

ISSN :
1757790X
Volume :
15
Database :
OpenAIRE
Journal :
BMJ Case Reports
Accession number :
edsair.doi.dedup.....0b5868733c7a48193e3e4e538b59f340
Full Text :
https://doi.org/10.1136/bcr-2022-249618